Marshall, Sinema, and Thune Introduce Legislation to Put Patients over Paperwork

(Washington, D.C., October 20, 2021) – Today, U.S. Senators Roger Marshall, M.D. (R-KS), Krysten Sinema (D-AZ), and John Thune (R-SD) introduced the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would improve timely access to quality care for seniors under Medicare Advantage. Specifically, the bill would modernize the way Medicare Advantage plans and health care providers use prior authorization. This legislation addresses the number one administrative issue for physicians today, and will make the delivery of health care more patient and doctor friendly.

“Having served as a physician in rural Kansas for decades, my top priority has always been to provide quality care to my patients,” said Senator Marshall. “This legislation cuts the red tape hindering health care providers across the nation from providing our seniors with quality care in a timely manner. The common-sense solutions we are offering were formed in partnership with hundreds of national and state organizations over the last two years, and I am honored to lead this bipartisan, bicameral effort alongside Senators Sinema and Thune.”

“Modernizing the prior authorization process allows Arizona seniors with Medicare Advantage plans to receive timely, quality health services while lowering the costs related to delayed care. Our bill also allows physicians and health care providers in Arizona to spend less time on burdensome red tape, and more time with their patients,” said Senator Sinema.

“I’m proud to support this bipartisan legislation that makes health care more efficient and patient-centered,” said Senator Thune. “By implementing electronic prior authorization, providers are able to reduce delays and help seniors in South Dakota get quicker access to the treatment and care they need.”

The Improving Seniors’ Timely Access to Care Act has amassed support from over 320 national and state organizations representing patients, health care providers, medical device manufacturers, and health IT companies across the country.

“The bill is a carefully crafted, bipartisan work product that reflects significant input from all direct stakeholders,” said Katie Orrico, SVP for Health Policy and Advocacy at the American Association of Neurological Surgeons/Congress of Neurological Surgeons and leader of the Regulatory Relief Coalition. “The congressional team behind this bill focused on transparency, oversight, and modernization of the Medicare Advantage program to benefit patients and the providers and health plans who serve them. We eagerly await congressional action.  The bill is ready for the finish line.”

“Physicians know the best treatment for our patients but they’re often not the ones making the final decision due to artificial barriers constructed by insurance companies,” said American Medical Association President Gerald E. Harmon, M.D. “The time delays and administrative burdens associated with prior authorization continue to undermine our patients’ health. Nearly a third of physician respondents to a 2020 AMA survey reported that prior authorization led to a serious adverse event — such as hospitalization, medical intervention to prevent permanent impairment, or even disability or death — for a patient in their care. The AMA thanks Senators Marshall, Sinema, and Thune for putting patients first by introducing the Improving Seniors’ Timely Access to Care Act, which would simplify and streamline the prior authorization processes in Medicare Advantage.”

“Hospitals and health systems strongly support the Improving Seniors’ Timely Access to Care Act because physicians, nurses and other providers of care should be able to spend their time on patients, not burdensome paperwork,” said Stacey Hughes, executive vice president at the American Hospital Association. “Efforts to streamline and standardize prior authorization are long overdue. Used appropriately, prior authorization can be a helpful tool for ensuring patients receive the right treatment, but too often the process results in delayed care, clinician burnout and unnecessary waste in the health care system. The AHA is eager to continue to work with Senators Marshall, Sinema and Thune to make improvements to the prior authorization process that protect patients.” 

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 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, the bipartisan legislation would:

  • establish an electronic prior authorization process that would streamline approvals and denials;
  • establish national standards for clinical documents that would reduce administrative burdens 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
  • require beneficiary protections that would ensure the electronic prior authorization serves seniors first. 

The House companion – led by Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, M.D. (D-CA), and Larry Bucshon, M.D. (R-IN) – was reintroduced in May.

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