Kelly, DelBene celebrate Ways & Means Committee's unanimous passage of 'Improving Seniors' Timely Access to Care Act'

WASHINGTON, D.C. -- Today, U.S. Representatives Mike Kelly (PA-16) and Suzan DelBene (WA-01) released a joint statement after their legislation, H.R. 3514, the "Improving Seniors' Timely Access to Care Act," passed the Ways & Means Committee. The legislation passed unanimously by a vote of 42-0.

The legislation, which has a bipartisan supermajority of nearly 300 House co-sponsors, now advances to the full U.S. House of Representatives for consideration.

"We are incredibly pleased to see the Improving Seniors' Timely Access to Care Act advance out of our committee and move to the full U.S. House of Representatives," the Members said. "This legislation puts patient care and patient outcomes first, and it will greatly modernize and streamline the prior authorization process. Today's vote moves this critical legislation one step closer to becoming law."

"Patients should be able to make medical decisions with their doctors without unnecessary red tape standing in the way," said Ways and Means Committee Chairman Jason Smith (MO-08). "The Improving Seniors' Timely Access to Care Act builds on the Ways and Means Committee's bipartisan work to improve the prior authorization process and ensure Pennsylvania seniors have timely access to the treatments and care that are best for them. Medicare Advantage insurers should not excessively use prior authorization as a barrier to delay needed care. I appreciate Representative Kelly's leadership in advancing reforms that increase transparency, reduce burdens, and put patients and their doctors back in charge of health care decisions."

You can WATCH and DOWNLOAD Kelly's full committee remarks in the YouTube link above.

BACKGROUND

Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. But it's not without fault. The current system often results in unconfirmed faxes of a patient's medical information or phone calls by clinicians which takes precious time away from delivering quality and timely care.

Prior authorization continues to be the #1 administrative burden identified by health care providers, and three out of four Medicare Advantage enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS OIG released a report finding that MA plans incorrectly denied beneficiaries' access to services even though they met Medicare coverage rules

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.

More than 35 million American seniors, including more than 1.5 million Pennsylvanians, are enrolled in Medicare Advantage.

Specifically, the bill 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 its use.
• Clarify HHS' authority to establish timeframes for e-prior authorization requests including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.

Previously, Rep. Kelly led similar legislation in the 118th Congress. The Improving Seniors' Timely Access to Care Act unanimously passed the House in the 117th Congress and was cosponsored by a majority of members in the Senate and House of Representatives.

The bill text can be found here and a section-by-section can be found here.