American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS Supports Legislation to Address Prior Authorization in Medicare Advantage

Reps. Suzan Delbene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera MD (D-CA), introduced legislation this week, The Improving Seniors’ Timely Access to Care Act, H.R. 3107, which would protect patients from unreasonable Medicare Advantage (MA) plan prior authorization requirements. MA plans originally required physicians to obtain prior authorization as a means of controlling costs by reducing medically unnecessary tests and procedures. However, health plans now widely use prior authorization indiscriminately, creating hurdles and hassles for patients and their physicians, which can lead to delays or denials of necessary care.

The Improving Seniors’ Timely Access to Care Act would bring greater transparency to the prior authorization process by requiring MA plans to report to the Centers for Medicare & Medicaid Services (CMS) on the extent of their use of prior authorization and the rate of approvals or denials by service and/or prescription medication. More than 100 members of Congress called for such reform in an ACS-supported bipartisan letter to CMS last year.

For further information, contact Carrie Zlatos, Senior Congressional Lobbyist, at czlatos@facs.org.