capitol hill report: Crucial prior authorization bill introduced in congress

The Improving Seniors’ Timely Access to Care Act (The Seniors’ Act) was introduced in Congress this month by Senators Roger Marshall, MD (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), and Sherrod Brown (D-OH), and by Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Ami Bera, MD (D-CA), and Larry Bucshon, MD (R-IN). In a strong show of early bipartisan support, the legislation was introduced with 45 senators and 130 representatives as original cosponsors.

The Improving Seniors’ Timely Access to Care Act (S.4532/H.R.8702) has been a top priority of the Academy since its first introduction in 2019. An updated version of the bill was reintroduced to best position the legislation to move forward in the current political and legislative environment.

The Seniors’ Act would:

• Establish an electronic prior authorization process for Medicare Advantage (MA) plans, including a standardization for transactions and clinical attachments
• Increase transparency around MA prior authorization requirements and their use
• Provide a pathway for the Centers for Medicare & Medicaid Services (CMS) to institute real-time decisions for routinely approved items and services in the future and clarify CMS’ authority to establish timeframes for electronic PA requests, including expedited determinations, real-time decisions for routinely approved items and services, and any other PA request
• Expand beneficiary protections to improve enrollee experiences and outcomes
• Require the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to improve the e-PA process

The AAN has been working on improving the prior authorization process from every facet of its advocacy efforts. Last Congress, the Seniors’ Act passed the House with 327 cosponsors. Additionally, 233 Representatives and 61 Senators signed a letter urging the Department of Health and Human Services and CMS to finalize rules aimed at prior authorization reform. The newly introduced Seniors’ Act codifies many important provisions put forth by CMS, of which the AAN was instrumental in achieving through the regulatory process.

AAN state advocacy has also been very active in supporting prior authorization reform legislation in 2024. Victories this year include PA reform passing in Oklahoma, Vermont, Colorado, and New Jersey. The AAN weighed in with letters and action alerts from AAN members in their respective states to get the bills across the finish line.