WASHINGTON, D.C. – The Society for Cardiovascular Angiography and Interventions (SCAI), in collaboration with other national physician specialty organizations belonging to the Regulatory Relief Coalition (RRC), applauds Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) for the reintroduction of the Improving Seniors’ Timely Access to Care Act of 2021. The legislation – H.R. 3173 – provides much-needed oversight and transparency of Medicare Advantage (MA) plans and helps protect patients from unnecessary delays in care by streamlining and standardizing the prior authorization process.
Similar legislation (H.R. 3107), introduced in the 116th Congress, received more than 280 co-sponsors, making it one of the most evenly bipartisan and widely supported health care bills 2019. The new legislation contains modest changes from the previous legislation. Differences between the previous legislation (H.R. 3107) and the reintroduced legislation (H.R. 3173) can be found here.
Prior authorization is a cumbersome process that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. The process for obtaining this approval is lengthy and typically requires physicians or their staff to spend the equivalent of two or more days each week negotiating with insurance companies —time and resources that would be better spent taking care of patients. While the importance reducing health care costs is understood, patients are now experiencing significant barriers to medically necessary care due to prior approval requirements for items and services that are eventually and routinely approved.
“Prior authorization is costly and time consuming,” said Timothy D. Henry, MD, MSCAI, SCAI president. “The Improving Seniors’ Timely Access to Care Act of 2021 works to reform this process and improve patient outcomes. This type of ‘red tape’ is bad for patients, bad for physicians and bad for taxpayers,” Dr. Henry continued.
The Improving Seniors’ Timely Access to Care Act of 2021 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.
In early May, SCAI’s interventional cardiologists convened virtually with legislators to ensure that the Improving Seniors’ Timely Access to Care Act of 2021 is considered by Congress during SCAI’s Virtual Fly-In. SCAI looks forward to further working with Congress to advance this bipartisan legislation.
The Society for Cardiovascular Angiography and Interventions is a professional organization representing more than 4,000 invasive and interventional cardiology professionals in approximately 75 nations. SCAI’s mission is to promote excellence in invasive/interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care.