CMA applauds House passage of prior authorization reform to protect patient care

September 14, 2022

A bill that will reform prior authorization for Medicare managed care plans has passed the U.S. House of Representatives unanimously in a voice vote. The legislation — the Improving Timely Access to Care for Seniors Act of 2022 (HR 3173) — provides comprehensive reform of the Medicare Advantage pre-approval process by streamlining health plan bureaucracy to help Medicare patients get the care they need – when they need it.

The California Medical Association (CMA) strongly supports this bill and is working to pass it before Congress adjourns in December. The CMA thanks California members of Congress for bringing forward the bill and we urge the Senate to act quickly to get it across the finish line.

“The CMA applauds the bipartisan support for this important legislation, which will ensure that quality patient care remains the top priority – not the bottom line of business,” said CMA President Robert E. Wailes, MD. placing unnecessary barriers so patients get the care they need, when they need it.

Prior authorization requirements can be difficult for patients, creating barriers to care and increasing administrative burdens for physicians who must spend time and resources obtaining approvals as insurance companies design and administer systems increasingly complex prior authorization.

Physician surveys have consistently revealed that excessive authorization checks required by health insurers are consistently responsible for serious harm when necessary medical care is delayed, denied, or interrupted in an effort to increase health insurers’ profits. . In a 2021 AMA survey, 93% of physicians reported delays in care due to unnecessary prior authorization requirements. Specifically, 90% of physicians said prior authorizations had a negative impact on patient clinical outcomes, with 34% of physicians stating that prior authorization resulted in a serious adverse event for a patient in their care, such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death. Additionally, physicians and their staff spend nearly two days a week on administratively heavy pre-approvals instead of spending more time with patients.

A recent report from the US Department of Health and Human Services and the Office of Inspector General found that Medicare Advantage plans improperly deny needed care to tens of thousands of patients each year.

HR 3173 will streamline Medicare Advantage pre-authorization for routinely approved services, ensure plans adhere to evidence-based guidelines developed by physicians, mandate public notification of pre-authorization decisions and timelines, and will implement an electronic process to reduce administrative burdens for physicians.

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