ACP urges support for prior authorization reform by the end of 2024

Before Congress adjourns at the end of this year, the American College of Physicians (ACP) urges them to take immediate action to support legislation that would streamline the prior authorization (PA) approval process in Medicare Advantage (MA) plans, reducing associated administrative burdens. The Improving Seniors’ Timely Access to Care Act of 2024 (S. 4532/H.R. 8702) would amend title XVIII of the Social Security Act to establish requirements with respect to the use of PA under MA plans, expediting the timeline for PA approval.

“The Improving Seniors’ Timely Access to Care Act would codify and enhance elements of a final rule issued by the Biden administration that mandates MA plans expedite the timeline for prior authorization approval,” Brian Buckley, ACP senior associate for legislative affairs, said in an ACP release. “ACP members should contact their representatives in the House and Senate and urge them to pass this bill before Congress adjourns at the end of the year.”

If passed, the bill would:

• Mandate that MA plans adopt electronic capabilities to streamline the PA approval process.
• Protect beneficiaries from disruptions in care caused by PA requirements during periods of transition between MA plans.
• Standardize the process of reporting electronic PA criteria to MA plans, requiring MA plans to issue PA decisions in a timely manner.
• Ensure that all PA requests are reviewed by qualified medical personnel.
• Increase transparency requirements in the PA approval and denial process, requiring information specific to requests that were approved or denied by plans in the year prior.

The bill also includes a requirement for the Centers for Medicare & Medicaid Services (CMS) to issue a report on the implementation of real-time decisions, in addition to an analysis of enrollee impact, and clarification about CMS’s authority to modify time frames for making PA determinations.

After the legislation was introduced, and stalled, in 2019, the Biden administration reformed PA policies within MA on their own through the rule-making process. ACP, approving of the improvements to PA procedures, encourages Congress to solidify the changes and build on the progress.

“While we do not expect the Trump administration to reverse this rule, enactment of the legislation would provide assurance that it could only be changed by Congress in the future,” Buckley said.

The bill received a “zero score” from the Congressional Budget Office, meaning it is estimated to cost nothing. The ACP hopes that the zero score is enough to get the bill across the finish line before the end of 2024, with Buckley saying, “If it is not passed by the end of this calendar year, it would need to be reintroduced in the 119^th Congress.”