This bipartisan piece of legislation will tackle the overuse and abuse of prior authorization (PA) by some Medicare Advantage (MA) plans that is threatening access to patient care and increases provider administrative burden.  The bill was introduced with 47 senators and 73 representatives as original co-sponsors.  Further, over 140 organizations representing physicians, patients, the medical technology and biopharmaceutical industry, health plans, and others have already endorsed the legislation.  The SVS urges Congress to move swiftly to enact this bill into law, considering its overwhelming support and the fact that PA is often cited as a major barrier to delivering care.  Delays caused by PA can lead to worsened health outcomes, especially for those with chronic or urgent conditions, and increased overall health care costs.
 

The bill would ultimately codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024. In the previous Congress, the bill was supported by a super majority of members in the Senate (60), a majority in the House (232), and unanimously passed the House in 2022.

Specifically, the Seniors’ Act would:

• Establish an electronic prior authorization process for MA plans, including a standardization for transactions and clinical attachments.
• Increase transparency around MA prior authorization requirements and their use.
• Provide 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.
• 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.

Please help ensure that this important legislation gets passed by contacting your member of Congress.

It is time to prioritize patients, not paperwork!