Bill to streamline prior authorizations picks up steam with House committee support

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Legislation that could improve patient care while cutting administration time for physicians is inching forward in Washington, D.C.

Physicians praised a House Ways and Means Committee vote on July 26 to recommend legislation with provisions similar to the 2022 Improving Seniors’ Timely Access to Care Act. That bill attracted a swarm of supporters among physician groups, patient advocates, and lawmakers, but did not make it out of Congress.

But the House Ways and Means Committee has supported legislation with the same goal: “simplify, streamline, and standardize the use of prior authorization for the millions of patients in Medicare Advantage,” according to a summary by the American Medical Association (AMA).

“The House Ways and Means Committee should be applauded today for advancing thoughtful, bipartisan provisions that would bring much needed reforms to prior authorization processes in Medicare Advantage,” AMA President Jesse M. Ehrenfeld, MD, MPH, said in a statement after the committee vote.

“Reforming prior authorization – an insurance gambit that erects obstacles to patient care and creates massive bureaucratic hoops for physicians – is a pillar of the Recovery Plan for America’s Physicians,” Ehrenfeld said, referring to the AMA blueprint to improve U.S. health care. “The unfortunate reality is that prior authorization is overused, costly, inefficient, opaque, and responsible for patient care delays and denials that often lead to poor health care outcomes. As a result, American Medical Association consistently urges Congress to restrict its use in Medicare Advantage.”

Lawmakers speak out

AMA praised the work of Rep. Suzan DelBene (D-Washington), Rep. Mike Kelly (R-Pennsylvania), Rep. Ami Bera, MD (D-California), and Larry Bucshon, MD (R-Indiana), for their work on the legislation.

The four issued a joint statement following the House committee vote.

“The ‘Improving Seniors’ Timely Access to Care Act’ continues to gain momentum in the 118th Congress following unanimous passage in the U.S. House in the 117th Congress,” they said. “This passage, along with the endorsements of more than 500 organizations, signals that modernizing and streamlining the prior authorization process for the nearly 32 million Americans who are currently enrolled in Medicare Advantage is long overdue.

“This would allow our nation’s seniors to receive the care they are entitled to faster,” the lawmakers said. “As we continue to work with federal agencies on implementing complementary efforts, we appreciate the committee’s commitment to advancing our legislation. We look forward to continuing to work in a bipartisan manner with our House and Senate colleagues to advance these commonsense reforms.”

In her committee remarks, DelBene said seniors, their families, and providers are making multiple phone calls to insurance companies. Physicians and other providers spend an average of 13 hours a week on prior authorization, with paperwork for procedures ultimately approve more than 95% of the time.