Legislation on Prior Authorization Reintroduced in Congress

American College of Radiology® (ACR®)-supported prior authorization legislation — the Seniors’ Timely Access to Care Act — was introduced in both the U.S. House and Senate June 12. This legislation would establish several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans to reduce administrative burdens and improve patient care.

Introduced by U.S. Sens. Roger Marshall, MD (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), Sherrod Brown (D-OH), and U.S. Reps. Mike Kelly (R-PA), Suzan DelBene (D-WA), Larry Bucshon, MD (R-IN) and Ami Bera, MD (D-CA), the legislation has broad bicameral, bipartisan support. Specifically, the bill 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 its use.
• Clarify Centers for Medicare and Medicaid Services authority to establish timeframes for electronic PA requests, including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require the U.S. Department of Health and Human Services and other federal agencies to report to Congress on program integrity efforts and other ways to further improve the electronic PA process.

While the bill unanimously passed the House in the 117th Congress, it was not voted into law due to the high cost of implementation and political hurdles. Recent regulatory changes related to prior authorization and updated legislative text has enabled renewed support in the 118th Congress — with 41 Senators and 124 House members signed-on as original cosponsors to the legislation.

ACR, along with 370 endorsing organizations, is pleased to see this legislation reintroduced and looks forward to working with policymakers to address prior authorization.

If you have questions, contact Ashley Walton, ACR Government Affairs Director.