Sen. Marshall Prior Authorization Legislation Gaining Momentum with 17 Cosponsors and 450 Supporting Organizations

Senator Questions Health Care Providers at HELP Committee

(Washington, D.C., February 2, 2022) – U.S. Senator Roger Marshall, M.D.’s legislation to improve timely access to care by streamlining prior authorization for patients and health care providers continues to gain momentum to now include nine Republicans, eight Democrats, and 450 national and state organizations. Senator Marshall questioned health care leaders on the importance of his legislation, the Improving Seniors’ Timely Access to Care Act, during a Senate HELP Committee hearing yesterday saying in part,

“Prior authorization is the number one administrative burden facing physicians today across all specialties. As a physician myself, I know of the frustration… This burn out is leading to early retirement, it ties up nurses… it makes us all less productive…We have Senate Bill 3018 it’s bipartisan, bicameral as well. We have 17 sponsors, including eight Democrats, nine Republicans, 450 national and state organizations are sponsoring this legislation which would streamline prior authorization.”

You may click HERE or on the image below to watch Senator Marshall’s interaction during the committee hearing.

Background:

Prior authorization is a tool used by health plans to reduce spending from improper payments and unnecessary care by requiring physicians and other health care providers to get pre-approval for medical services. But it’s not without fault. The current system of unconfirmed faxes of a patient’s medical information or phone calls by clinicians takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers and nearly four out of five Medicare Advantage enrollees are subject to unnecessary delays. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization. Building on these principles, Senator Marshall’s bipartisan legislation would:

  • establish an electronic prior authorization process that would streamline approvals and denials;
  • create national standards for clinical documents that would reduce administrative burdens for health care providers and Medicare Advantage plans;
  • create a process for real-time decisions for certain items and services that are routinely approved;
  • increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients;
  • ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines; and
  • expand beneficiary protections that would ensure electronic prior authorization serves seniors first. 

In addition, Senator Marshall joined U.S. Senators Sherrod Brown (D-OH), John Thune (R-SD), and Kyrsten Sinema (D-AZ) in sending a letter to the U.S. Centers for Medicare and Medicaid Services’ requesting an update on their efforts to streamline prior authorization protocols across various programs. In the letter, the Senators encouraged the administration to use their bipartisan legislation as a framework for upcoming rules. Last month, HHS released a request for information on electronic prior authorization standards to ease the burden on providers – similar to the goals of the bill.

U.S. Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, M.D. (D-CA), and Larry Bucshon, M.D. (R-IN) introduced the companion legislation. Support has increased since its introduction and now has over 250 cosponsors.

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