SCAI strongly supports the Improving Seniors' Timely Access to Care Act, (H.R. 3173) reintroduced on May 13, 2021, by Representatives Suzan DelBene (D-Wash.), Mike Kelly (R-Penn.), Ami Bera, MD (D-Calif.), and Larry Buschon, M.D. (R-Ind). A companion bill has yet to be introduced in the Senate.
SCAI is a member of the Regulatory Relief Coalition (RCC), a group of national physician specialty organizations advocating for regulatory burden reduction in Medicare so that physicians can spend more time treating patients. More information on this important coalition can be found at www.regrelief.org.
The prior authorization of services by a Medicare Advantage plan requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. Unfortunately, this process often leads to lengthy inquires that burden physician staff and delays in-patient care. The regulatory burdens of prior authorization have amplified the risks for patients and burdens for practices during the COVID-19 crisis. To increase transparency and accountability, and to reduce the burdens of prior authorization in connection with Medicare Advantage plans, the Improving Seniors’ Timely Access to Care Act, would:
- Establish an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities;
- Require the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program;
- Standardize and streamline the prior authorization process for routinely approved items and services;
- Ensure prior authorization requests are reviewed by qualified medical personnel;
- Increase transparency around MA prior authorization requirements and their use; and
- Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.