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APTA-supported bipartisan legislation that takes on misuse of prior authorization in Medicare Advantage plans has been introduced in the 118th Congress in both the House and Senate. Known as the Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532), the bill doesn't completely eliminate the use of prior authorization but would move Medicare Advantage toward a more transparent and less burdensome process — a longtime policy goal for APTA.

The legislation was introduced on June 12 by Sens. Roger Marshall, MD, R-Kan.; Kyrsten Sinema, I-Ariz.; John Thune, R-S.D.; and Sherrod Brown, D-Ohio; and by Reps. Mike Kelly, R-Penn.; Suzan DelBene, D-Wash.; Larry Bucshon, R-Ind.; and Ami Bera, D-Calif. According to a press release, “This bipartisan legislation would remove unnecessary red tape, make health care more efficient, and ensure patients can access care when they need it.”  

Specifically, the bill would do several things: establish an electronic prior authorization process; require the Secretary of the U.S. Department of Health and Human Services to establish a process for “real-time decisions” for items and services that are routinely approved; require MA plans to provide more detailed reports on use of prior authorization to the U.S. Centers for Medicare & Medicaid Services (including their rates of approvals, denials, and average time for approvals); and press MA providers to do a better job of incorporating input from health care providers in their authorization programs and decisions.

A previous version of the bill came close to being enacted into law at the end of 2022 but stalled in the Senate before Congress adjourned.  The newly reintroduced bill has strong momentum behind it, with 135 co-sponsors in the House and 44 co-sponsors in the Senate already.

“Reducing administrative burden and unnecessary paperwork for PTs and PTAs, including the use of prior authorization, is one of APTA’s top public policy goals,” said Justin Elliot, APTA’s vice president of government affairs. “This APTA-supported legislation is an important step toward addressing the proliferation and abuse of prior authorization under Medicare Advantage, and it builds on the recent advocacy win aimed at CMS to put guardrails on prior authorization processes.”

APTA government affairs staff will monitor the progress of the bill in Congress and provide updates and opportunities. Members can contact their members of Congress and urge their support of the bill by going to APTA’s Action Center. If you want to get an even closer look at APTA's advocacy efforts on Capitol Hill and connect with other members interested in working for change, join the APTA Advocacy Network.

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