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AAO lauds Congress for passing key milestone for Prior Authorization Reform Bill

Article

The American Academy of Ophthalmology applauded Congress for reaching the 290-consponsor milestone for the proposal. By reaching the two-thirds majority of bipartisan support in Congress, the bill is eligible for inclusion on the Consensus Calendar under new rules that were established in 2019.

House Resolution 3173, the Improving Seniors’ Timely Access to Care Act of 2021 has reached the 290-cosponsor milestone, earning lawmakers kudos from the American Academy of Ophthalmology.

By reaching the two-thirds majority of bipartisan support in Congress, the bill is eligible for inclusion on the Consensus Calendar under new rules that were established in 2019.

Support for this much-needed legislation has grown since the original sponsors of the bill, Reps. Suzan DelBene, D-Wash., Mike Kelly,R-Pa., Ami Bera, D-Calif., and Larry Buschon, R-Ind,, introduced the proposal one year ago, on May 13, 2021.

H.R. 3173 would require electronic prior authorization, improve transparency for beneficiaries and providers alike, and increase Centers for Medicare & Medicaid Services (CMS) oversight on how Medicare Advantage (MA) plans use prior authorization.

The legislation would require Medicare Advantage plans to:

  • Establish an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities, including the ability to provide real-time decisions;
  • Annually publish specified prior authorization information, including average response time and the percentage of requests approved, to improve transparency;
  • Ensure prior authorization requests are reviewed by qualified medical personnel; and
  • Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.

More than 300 national and state patient, physician, health care professional and other health care stakeholder organizations have endorsed this legislation.

“The overwhelming and bipartisan support for the Improving Seniors’ Timely Access to Care Act is evidence that the relief we are fighting for is vital and urgent for our patients and our profession,” Stephen D. McLeod, MD, CEO of the American Academy of Ophthalmology, said in a news release. “We’re pleased that Congress recognizes the importance of addressing egregious prior authorization policies and we hope lawmakers take swift action to pass this common-sense legislation.”

According to the academy, a report from the U.S. Department of Health and Human Services Office of Inspector General found that Medicare Advantage plans denied prior authorization requests that met Medicare coverage rules and Medicare Advantage Organization billing rules 13 percent of the time, igniting a new push for action. More than 460 national and state patient, provider, and stakeholder organizations, including the American Academy of Ophthalmology, endorse The Improving Seniors’ Timely Access to Care Act.

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