Regulatory Relief Coalition announces support for the Improving Seniors’ Timely Access to Care Act

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The Regulatory Relief Coalition (RCC) a group of national physician specialty organizations, announced its support for the Improving Seniors’ Timely Access to Care (Seniors’) Act.

The legislation was introduced in Congress by Senators Sherrod Brown, D-Ohio, Roger Marshall, MD, R-Kansas, Kyrsten Sinema I-Arizona,and John Thune, R-South Dakota, and Sherrod Brown (D-OH), and by Representatives Mike Kelly, R-Pennsylvania, Suzan DelBene, D-Washington, Ami Bera, MD, D-California, and Larry Bucshon, MD, R-Indiana.¹

According to a news release, the bipartisan legislation was introduced with 42 Senators and 130 Representatives as original co-sponsors. Over 380 organizations representing patients, health care providers, the medical technology and biopharmaceutical industry, health plans and others endorse the legislation. The RRC calls for Congress to act swiftly to enact this legislation into law this year.²

George A. Williams, MD, senior secretary for advocacy of the American Academy of Ophthalmology, called for quick passage of the legislation.

“The swift passage of the Improving Seniors’ Timely Access to Care Act is an important action for Medicare beneficiaries and much-needed step for reducing unwarranted administrative burdens on the physicians and care for them.” Williams noted in a statement. “Seniors who enroll in Medicare Advantage plans deserve the same access to Medicare-covered items and services as beneficiaries who opt for Medicare fee-for-service. Congress should act quickly to make it a reality.”

Russell R. Lonser, MD, FAANS, chair of the department of neurosurgery at The Ohio State University and chair of the American Association of Neurological Surgeons and Congress of Neurological Surgeons Washington Committee, called the introduction of the legislation a pivotal moment for enhancing patients’ access to care.

“The widespread overuse of prior authorization, especially in Medicare Advantage, has led to unacceptable delays and denials of essential medical treatments,’ he said in the statement. “We are optimistic that this will be the year Congress acts to safeguard timely care for our seniors.”

The Seniors’ Act is bipartisan legislation that will tackle the overuse and abuse of prior authorization (PA) by Medicare Advantage (MA) plans, which threatens access to patient 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, 2024.¹

The sponsors of the legislation, in an effort to help ensure swift passage in Congress, made modest, mindful adjustments to the legislation to align with CMS’ final e-PA rule and to reduce the Congressional Budget Office 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.

The Seniors’ Act would:

• Establish an electronic prior authorization process for MA plans, including a standardization for transactions and clinical attachments.
• Increase transparency around MA prior authorization requirements and their use.
• Provide a pathway for CMS to institute real-time decisions for routinely approved items and services in the future and clarify CMS’ authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services and any other PA request.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to improve the e-PA process.

According to the news release, he RRC has been advocating for the Seniors’ Act since it was first introduced in 2019. In the 117th Congress, the bill passed the House with 380 combined co-sponsors — 53 senators and 327 representatives. In June 2023, 233 Representatives and 61 Senators showed their bipartisan support of PA reform in MA by urging the Department of Health and Human Services and CMS to finalize pending rules to reign in the overreaches of MA plans that delay and deny care through utilization management tools like PA.

The RRC is a leading advocate for reforming PA in the MA program on behalf of the more than 28 million seniors enrolled in MA plans and the providers who care for them. Members of the RRC are the American Academy of Dermatology Association, American Academy of Family Physicians, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Physical Medicine and Rehabilitation, American Association of Neurological Surgeons, American College of Cardiology, American College of Rheumatology, American Gastroenterological Association, American Osteopathic Association, American Society of Clinical Oncology and Congress of Neurological Surgeons. RRC Allies are the American Medical Rehabilitation Providers Association, National Association for Proton Therapy, Premier, and Select Medical.²

References

1. Ll S. 18TH CONGRESS 2D SESSION. Accessed June 12, 2024. https://regrelief.org/wp-content/uploads/2024/05/RIL24562.pdf

2. https://regrelief.org/wp-content/uploads/2024/06/RRC-Press-Release-RE-Seniors-Act.pdf