Specialty physicians and their patients are often subject to prior authorizations and other utilization management tactics in the Medicare Advantage program. These tactics delay patient's access to medically necessary care and create considerable, unnecessary administrative burdens for specialty physicians. The process for obtaining this approval is lengthy and typically requires physicians or their staff to spend the equivalent of two or more days each week negotiating with insurance companies — time that would better be spent taking care of patients. 

The SIR supported Improving Seniors’ Timely Access to Care Act (S. 1816/H.R. 3514) seeks to increase transparency and accountability and reduce the burdens of prior authorization in the MA program by establishing an electronic PA process for MA plans, increasing transparency around MA prior authorization requirements, providing a pathway for the Centers for Medicare and Medicaid Services (CMS) to institute real-time decisions for routinely approved items and services and clarify CMS’ authority to establish timeframes for e-PA requests, expanding beneficiary protections to improve enrollee experiences and outcomes, and requiring the U.S. Department of Health and Human Services to report to Congress on program integrity efforts and ways to further improve the e-PA process. 

Please call on your members of Congress to support this important legislation.