House committee advances radiology-backed legislation to curb prior authorization

Members of Congress recently advanced radiologist-backed legislation aimed at curbing prior authorization in the Medicare Advantage program. 

The Energy and Commerce Health Subcommittee on June 25 voted to approve HR 3514 for further consideration by the full House of Representatives. Dubbed the “Improving Seniors’ Timely Access to Care Act,” the bill seeks to streamline the “often cumbersome and time-consuming” task of approving requests for medical imaging and other services. 

It has drawn widespread support from the House of Medicine, with the Society of Interventional Radiology and American Medical Association both voicing their support on Thursday. 

“This bipartisan legislation would eliminate unnecessary administrative red tape in Medicare Advantage to ensure that critical, lifesaving care is no longer delayed by an overused prior authorization process,” AMA CEO John Whyte, MD, MPH, said in a statement June 25. “We thank sponsors, Reps. Mike Kelly [R-Pa.] and Suzan DelBene [D-Wash.] and subcommittee leadership for prioritizing patient needs over paperwork and look forward to working with lawmakers to enact this vital reform.” 

Premier Inc.—a group-purchasing and data-analytics firm that works with hospitals—also touted its support for the legislation on Thursday. It contends that “antiquated” manual processes continue to delay care in time-sensitive situations, “adding unnecessary burden for clinicians and patients alike.” A recent survey of Premier member organizations found that Medicare Advantage prior authorization delays and denials “threaten patient access,” costing providers an estimated $19.7 billion annually to manage. 

“Greater transparency and streamlined, technology-enabled processes are critical to addressing these challenges and supporting accessible, high quality care,” John Knapp, Premier’s VP of advocacy, said in a statement June 25. 

The legislation has nearly 250 co-sponsors, Rep. Kelly reported earlier this year. If passed, the bill would establish a new electronic prior authorization process, including standardizing transactions and clinical attachments. It also would increase transparency around prior authorization in Medicare Advantage, clarify HHS’ authority to establish timeframes for these requests, and expand beneficiary protections. 

"If we can avoid the politics and talk about good policy, we can improve healthcare and lower costs for all Americans," Kelly said at a hearing with health insurance CEOs earlier this year. "[The legislation] would modernize and streamline the Medicare Advantage prior authorization process. Thirty-three million Americans, including 1.5 million Pennsylvanians, who rely on Medicare Advantage would greatly benefit from this legislation,” he added later.