U.S. Rep. Mike Kelly (R-PA) and U.S. Sen. John Thune (R-SD) led bipartisan, bicameral letters urging swift action by the Centers for Medicare & Medicaid Services (CMS) to finalize proposed rules that would update prior authorization processes so that senior citizens on Medicare could receive faster, improved care.
“We urge CMS to promptly finalize and implement these changes to increase transparency and improve the prior authorization process for patients, providers, and health plans,” wrote the lawmakers in June 21 letters sent to U.S. Department of Health and Human Services Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.
The lawmakers cited a 2022 American Medical Association physician survey showing that prior authorization has negatively impacted the health outcomes of patients 90 percent of the time, and one in three physicians report that prior authorization delays have led to a serious adverse health event, such as hospitalization or death.
“We appreciate that the rules CMS proposed in December 2022 concerning PA attempt to strike a balance between program integrity and patient access to care,” wrote Sen. Thune, Rep. Kelly, and their colleagues. “While we agree that PA, when used appropriately, is an important tool for payers to manage costs and ensure program integrity, we support CMS’s efforts to protect beneficiaries, increase transparency around PA requirements, and streamline this process for patients, providers, and health plans.”
The lawmakers also called on CMS to expand on the proposed rules by establishing a mechanism for real-time electronic prior authorization (e-PA) decisions for routinely approved items and services; requiring that plans respond to PA requests within 24 hours for urgently needed care; and requiring detailed transparency metrics, according to the identical letters signed by 233 members of the U.S. House of Representatives and 61 senators.
Such changes, they wrote, would bring the proposed rules more in line with the lawmakers’ bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, “which propose[d] a balanced approach to prior authorization in the [Medicare Advantage] program that would remove barriers to patients’ timely access to care and allow providers to spend more time treating patients and less time on paperwork.”
The bill unanimously passed the House during the previous session of Congress but languished in the Senate. It was cosponsored by a majority of House and U.S. Senate members and was endorsed by more than 500 healthcare organizations.
“We urge you to finalize these important updates to prior authorization processes in a manner that reflects the Improving Seniors’ Timely Access to Care Act as quickly as possible in order to improve access to health care for patients,” wrote the lawmakers.