Sunflower State News

Washington, D.C.– On June 22, U.S. Senator Roger Marshall, M.D. (KS), Kyrsten Sinema (AZ), John Thune (SD), Sherrod Brown (OH), and U.S. Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera, M.D. (CA-06), and Larry Bucshon, M.D. (IN-08) sent letters to the U.S. Centers for Medicare & Medicaid Services (CMS) urging the agency to quickly finalize a set of proposed rules that would make healthcare more doctor and patient friendly under Medicare Advantage. Specifically, the rules would modernize the prior authorization processes, effectively implementing their groundbreaking legislation, the Improving Seniors’ Timely Access to Care Act (S. 3018 / H.R. 3173).

“We urge CMS to promptly finalize and implement these changes to increase transparency and improve the prior authorization process for patients, providers, and health plans,” wrote the lawmakers. “We are pleased that these proposed rules align with the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, which proposes a balanced approach to prior authorization in the [Medicare Advantage] program that would remove barriers to patients’ timely access to care and allow providers to spend more time treating patients and less time on paperwork.”

In the letters signed by 61 Senators and 233 Representatives, the lawmakers also call on CMS officials to enhance the proposals to include real-time electronic decision-making for routinely approved services, require faster responses on emergency procedures from 72 to 24 hours, and include greater transparency requirements. This would bring the rules more in line with the lawmakers’ legislation. In December, Senator Marshall and his colleagues issued statements commending CMS for taking the first step to implement their legislation through the rulemaking process.

Background

The Improving Seniors’ Timely Access to Care Act unanimously passed the House last Congress and was cosponsored by a majority of members in the Senate and House of Representatives. Since its introduction, over 500 organizations that represent patients, physicians, hospitals, and other key stakeholders in the health care industry have officially endorsed the legislation.

According to an American Medical Association physician survey, prior authorization has negatively impacted the health outcomes of patients 90 percent of the time, and 1 in 3 physicians report that prior authorization delays have led to a serious adverse health event, such as hospitalization or even death. 

Last year, the U.S. Department of Health & Human Services Inspector General issued a scathing report that detailed how Medicare Advantage plans routinely denied care to seniors that they were entitled to receive under Medicare rules and required unnecessary documentation to delay or deny care. 

A copy of the Senate and House letters can be found here.

Original source can be found here.