MGMA urges passage of prior authorization reform legislation (October 14, 2024)

October 14, 2024 
 

Subject: Request to Pass the Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532)

Speaker Johnson, Leaders Schumer, Jeffries, and McConnell:

On behalf of the Regulatory Relief Coalition (RRC), a coalition of national physician organizations and our allies seeking to reduce regulatory burdens that interfere with patient care, we urge you to prioritize passage this session of the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532) which has overwhelming stakeholder support and is urgently needed to reduce delays in health care for our nation’s seniors.

The Improving Seniors’ Timely Access to Care Act is bipartisan legislation that will tackle the overuse and abuse of prior authorization (PA) by Medicare Advantage (MA) plans, which threatens access to medically-necessary care and increases provider administrative burden. The bill would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.

In an effort to help ensure swift passage in Congress, the bill sponsors made modest, mindful adjustments to the legislation to align with CMS’ final e-PA rule and to reduce the Congressional Budget Office (CBO) score. Changes include a requirement for CMS to issue a report on implementing real-time decisions, an analysis on enrollee impact, and clarifying CMS’s authority to modify the timeframes for making PA determinations. To facilitate passage, we ask that you work with the leaders of the relevant committees of jurisdiction to expedite Congressional Budget Office (CBO) scoring of the new bill.

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