Lawmakers line up to support CMS rules to streamline prior authorizations

Senators are supporting proposed regulations that would streamline the prior authorization process for physicians and patients using Medicare Advantage plans.

This month, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the draft rule with five key provisions and five requests for information. If implement, CMS estimated the changes would save physicians and hospitals more than $15 billion over 10 years.

This fall, medical organizations have hammered Congress to pass the Improving Seniors’ Timely Access to Care Act, a bill that would make it easier for senior patients to get care by modernizing the prior authorization process. The U.S. House of Representatives in September passed the legislation, which remains pending in the Senate.

The CMS action would bring that legislation closer to reality, said bill cosponsor Sen. Roger “Doc” Marshall, MD, R-Kansas. He announced his support of the CMS action and noted the bill has bipartisan support in the House and Senate, along with backing by 500 organizations representing patients, physicians, hospitals, and other stakeholders in the health care industry.

In a published statement, Marshall called the CMS proposal “proof that this is truly a good faith effort to make health care better for America’s seniors.”

As an obstetrician-gynecologist, Marshall cited his own experience as a physician and hospital manager facing challenges to patient care, when waiting for prior authorizations.

“There’s a reason why the Improving Seniors’ Timely Access to Care Act is one of the most popular bills this Congress,” Marshall said in his statement. “I’m grateful for all the hard work that has gone into creating significant momentum for this bill – for it is this hard work that brings us closer to getting this over the finish line before the new Congress.”

Marshall’s statement included comments from House and Senate cosponsors including Rep. Suzan DelBene D-Washington; Rep. Ami Bera, MD, D-California; Larry Bucshon, MD, R-Indiana; Rep. Mike Kelly, R-Pennsylvania; Sen. Kyrsten Sinema, I-Arizona; Sen. John Thune, R-South Dakota; and Sen. Sherrod Brown, D-Ohio.