The American Academy of Ophthalmology Commends Congress for Reaching Significant Milestone on Prior Authorization Reform Bill

The American Academy of Ophthalmology stated that is commends the US House of Representatives for surpassing the 290-cosponsor milestone in support of H.R. 3173, the "Improving Seniors’ Timely Access to Care Act of 2021." Attaining the two-thirds majority of bipartisan support in Congress makes the bill eligible for inclusion on the Consensus Calendar under new rules established in 2019. 

Support for the legislation has grown since the original sponsors of the bill, Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera (D-CA), and Larry Buschon (R-IN), introduced it on May 13, 2021, according to AAO. 

"If enacted, the Improving Seniors’ Timely Access to Care Act would streamline and standardize prior authorization in the Medicare Advantage (MA) program, providing much-needed oversight and transparency while protecting beneficiaries from unnecessary care delays and denials," AAO stated in a news release. The legislation would require Medicare Advantage plans to:

• Establish an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities, including the ability to provide real-time decisions;
• Annually publish specified prior authorization information, including average response time and the percentage of requests approved, to improve transparency;
• Ensure prior authorization requests are reviewed by qualified medical personnel; and
• Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.

"The overwhelming and bipartisan support for the Improving Seniors' Timely Access to Care Act is evidence that the relief we are fighting for is vital and urgent for our patients and our profession," said Stephen D. McLeod, MD, CEO of the American Academy of Ophthalmology. “We’re pleased that Congress recognizes the importance of addressing egregious prior authorization policies and we hope lawmakers take swift action to pass this common-sense legislation.” 

A new report from the U.S. Department of Health and Human Services Office of Inspector General found that Medicare Advantage plans denied prior authorization requests that met Medicare coverage rules and Medicare Advantage Organization billing rules 13 percent of the time, igniting a new push for action. More than 460 national and state patient, provider, and stakeholder organizations, including the American Academy of Ophthalmology, endorse The Improving Seniors’ Timely Access to Care Act.