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- Congress Reintroduces CAP-Supported Prior Authorization Reform Bill
A bipartisan group of senators and representatives reintroduced the Improving Seniors’ Timely Access to Care Act, which would streamline the prior authorization process under Medicare Advantage to better serve patients and reduce unnecessary administrative burdens for clinicians. This bill is supported by the CAP, over 380 national and state health care organizations, 42 Senators, and 130 House members.
In September 2022, the House passed the bill that was cosponsored by a majority of members of both the House and Senate. Since then, the Senate and House have been working with the Centers for Medicare & Medicaid Services (CMS) to advance the legislation to the President’s desk, but the bill’s cost has been a factor.
On January 18, the CMS released a final rule that makes important reforms in prior authorization programs for medical services. The rule is a direct result of important advocacy efforts taken by the CAP together with the American Medical Association and other physician organizations to address prior authorization in government-regulated health plans.
The CAP, the AMA and others have been advocating for prior authorization reform at the state and federal level for many years, which includes:
- increased clinical validity of coverage criteria
- restrictions on retroactive denials after prior authorization approvals
- a grace period for patients switching plans to promote continuity of care
- greater physician-patient autonomy in determining where care can be provided and by whom
- prior authorization information at the point-of-care
To see the list of health care organizations who support the bill, click here.