Renewed optimism that radiologist-supported bill to ease prior authorization could pass by year’s end

There is renewed optimism that a radiologist-supported bill to ease prior authorization could pass before Congress adjourns for the year. 

U.S. senators first introduced the Improving Seniors’ Timely Access to Care Act in June. The bipartisan bill would simplify how payers process healthcare utilization requests in Medicare Advantage—establishing an electronic process, increasing transparency, and expediting decisions for routinely approved healthcare services. 

Lawmakers already approved the measure in the House. However, it ran into a roadblock in the Senate after the Congressional Budget Office estimated in 2022 that the measure could cost the government $16.2 billion over 10 years. On Wednesday, the American Society of Nuclear Cardiology noted that the legislation has seen a breakthrough, with the hefty price tag now disappearing. 

“House members revised some of the earlier bill’s costlier provisions toward budget neutrality,” ASNC said in a Nov. 13 news update. “For example, the revised legislation would require Medicare Advantage plans to report their approval and denial rates, develop electronic prior authorization to streamline approvals, and encourage adherence to evidence-based guidelines. Reports indicate the CBO is unofficially telling legislators’ offices that the expected cost of the new version of the bill is budget neutral.”

MedPage Today published one such report on Nov. 1, quoting the American Medical Association and Medical Group Management Association, which both support the bill alongside 500 other healthcare organizations. Experts noted that the updated CBO score represents a final hurdle to push the Improving Seniors’ Timely Access to Care Act over the finish line. The bill now boasts 221 cosponsors in the House and 54 in the Senate. 

AMA President Bruce Scott, MD, said he believes the legislation “makes a lot of sense,” with prior authorization a key driver of frustration, burnout and administrative burden. He said he often finds himself on the phone with someone from an insurance company who is not a physician and has no knowledge about medical necessity. 

“There was one [instance] where I wanted to get a CT scan in an area of the neck and the person was denying it because they thought it was for [something in] the nasal sinus,” Scott told MedPage. “I said, 'You do understand the tumor is in the person's voice box, in their neck?' The person didn't know the part of the body the tumor was growing in, and she was making the decision as to whether it would be allowed or not."

MGMA recently listed prior authorization reform as one of its top legislative priorities in the lame-duck session following the election. ASNC, meanwhile, also is urging physicians to contact their member of congress to pass the policy soon. 

“The Improving Seniors’ Timely Access to Care Act (S. 4532/H.R. 8702) will tackle the overuse and abuse of PA by Medicare Advantage plans, which threatens access to medically necessary care and increases provider administrative burden,” ASNC said Wednesday. 

Meanwhile, the AMA House of Delegates this week also passed a resolution advocating for legislative action when an insurer refuses to cover preauthorized care.