The Academy is supporting S.1816/ H.R. 3514, the Improving Seniors’ Timely Access to Care Act (Seniors’ Act). This bipartisan legislation, introduced by ophthalmology’s Congressional champions in both the House and the Senate, will protect patients from unnecessary delays by streamlining and standardizing the prior authorization process in Medicare Advantage plans, while also providing critical oversight and transparency of health insurance for America’s seniors. 

If enacted into law, the Seniors’ Act would improve the prior authorization process by:  

• Establishing electronic prior authorization (e-PA) for MA plans, including standardization of transactions and clinical attachments.
• Increasing transparency around MA prior authorization requirements, and how often the denials are reversed.
• Providing a pathway for CMS to institute real-time decisions for routinely approved items and services in the future and clarify CMS’ authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services and any other PA request. 
• Expanding beneficiary protections to improve enrollee experiences and outcomes.
• Requiring the U.S. Department of Health and Human Services (HHS) and other agencies to report to Congress on program integrity efforts and other ways to improve the e-PA process.

Make sure your voice is heard. Contact your members of Congress and urge them to cosponsor and pass S.1816/ H.R. 3514, the Improving Seniors’ Timely Access to Care Act.