Improving Seniors' Timely Access to Care Act of 2022

Floor Speech

BREAK IN TRANSCRIPT

Ms. DelBENE. Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 3173) to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans, and for other purposes, as amended.

The Clerk read the title of the bill.

The text of the bill is as follows: H.R. 3173

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE.

This Act may be cited as the ``Improving Seniors' Timely Access to Care Act of 2022''. SEC. 2. ESTABLISHING REQUIREMENTS WITH RESPECT TO THE USE OF PRIOR AUTHORIZATION UNDER MEDICARE ADVANTAGE PLANS.

(a) In General.--Section 1852 of the Social Security Act (42 U.S.C. 1395w-22) is amended by adding at the end the following new subsection:

``(o) Prior Authorization Requirements.--

``(1) In general.--In the case of a Medicare Advantage plan that imposes any prior authorization requirement with respect to any applicable item or service (as defined in paragraph (5)) during a plan year, such plan shall--

``(A) beginning with the third plan year beginning after the date of the enactment of this subsection--

``(i) establish the electronic prior authorization program described in paragraph (2); and

``(ii) meet the enrollee protection standards specified pursuant to paragraph (4); and

``(B) beginning with the fourth plan year beginning after the date of the enactment of this subsection, meet the transparency requirements specified in paragraph (3).

``(2) Electronic prior authorization program.--

``(A) In general.--For purposes of paragraph (1)(A), the electronic prior authorization program described in this paragraph is a program that provides for the secure electronic transmission of--

``(i) a prior authorization request from a provider of services or supplier to a Medicare Advantage plan with respect to an applicable item or service to be furnished to an individual and a response, in accordance with this paragraph, from such plan to such provider or supplier; and

``(ii) any attachment relating to such request or response.

``(B) Electronic transmission.--

``(i) Exclusions.--For purposes of this paragraph, a facsimile, a proprietary payer portal that does not meet standards specified by the Secretary, or an electronic form shall not be treated as an electronic transmission described in subparagraph (A).

``(ii) Standards.--An electronic transmission described in subparagraph (A) shall comply with--

``(I) applicable technical standards adopted by the Secretary pursuant to section 1173; and

``(II) other requirements to promote the standardization and streamlining of electronic transactions under this part specified by the Secretary.

``(iii) Deadline for specification of additional requirements.--Not later than July 1, 2023, the Secretary shall finalize requirements described in clause (ii)(II).

``(C) Real-time decisions.--

``(i) In general.--Subject to clause (iv), the program described in subparagraph (A) shall provide for real-time decisions (as defined by the Secretary in accordance with clause (v)) by a Medicare Advantage plan with respect to prior authorization requests for applicable items and services identified by the Secretary pursuant to clause (ii) if such requests are submitted with all medical or other documentation required by such plan.

``(ii) Identification of items and services.--

``(I) In general.--For purposes of clause (i), the Secretary shall identify, not later than the date on which the initial announcement described in section 1853(b)(1)(B)(i) for the third plan year beginning after the date of the enactment of this subsection is required to be announced, applicable items and services for which prior authorization requests are routinely approved.

``(II) Updates.--The Secretary shall consider updating the applicable items and services identified under subclause (I) based on the information described in paragraph (3)(A)(i) (if available and determined practicable to utilize by the Secretary) and any other information determined appropriate by the Secretary not less frequently than biennially. The Secretary shall announce any such update that is to apply with respect to a plan year not later than the date on which the initial announcement described in section 1853(b)(1)(B)(i) for such plan year is required to be announced.

``(iii) Request for information.--The Secretary shall issue a request for information for purposes of initially identifying applicable items and services under clause (ii)(I).

``(iv) Exception for extenuating circumstances.--In the case of a prior authorization request submitted to a Medicare Advantage plan for an individual enrolled in such plan during a plan year with respect to an item or service identified by the Secretary pursuant to clause (ii) for such plan year, such plan may, in lieu of providing a real-time decision with respect to such request in accordance with clause (i), delay such decision under extenuating circumstances (as specified by the Secretary), provided that such decision is provided no later than 72 hours after receipt of such request (or, in the case that the provider of services or supplier submitting such request has indicated that such delay may seriously jeopardize such individual's life, health, or ability to regain maximum function, no later than 24 hours after receipt of such request).

``(v) Definition of real-time decision.--In establishing the definition of a real-time decision for purposes of clause (i), the Secretary shall take into account current medical practice, technology, health care industry standards, and other relevant information relating to how quickly a Medicare Advantage plan may provide responses with respect to prior authorization requests.

``(vi) Implementation.--The Secretary shall use notice and comment rulemaking for each of the following:

``(I) Establishing the definition of a `real-time decision' for purposes of clause (i).

``(II) Updating such definition.

``(III) Initially identifying applicable items or services pursuant to clause (ii)(I).

``(IV) Updating applicable items and services so identified as described in clause (ii)(II).

``(3) Transparency requirements.--

``(A) In general.--For purposes of paragraph (1)(B), the transparency requirements specified in this paragraph are, with respect to a Medicare Advantage plan, the following:

``(i) The plan, annually and in a manner specified by the Secretary, shall submit to the Secretary the following information:

``(I) A list of all applicable items and services that were subject to a prior authorization requirement under the plan during the previous plan year.

``(II) The percentage and number of specified requests (as defined in subparagraph (F)) approved during the previous plan year by the plan in an initial determination and the percentage and number of specified requests denied during such plan year by such plan in an initial determination (both in the aggregate and categorized by each item and service).

``(III) The percentage and number of specified requests submitted during the previous plan year that were made with respect to an item or service identified by the Secretary pursuant to paragraph (2)(C)(ii) for such plan year, and the percentage and number of such requests that were subject to an exception under paragraph (2)(C)(iv) (categorized by each item and service).

``(IV) The percentage and number of specified requests submitted during the previous plan year that were made with respect to an item or service identified by the Secretary pursuant to paragraph (2)(C)(ii) for such plan year that were approved (categorized by each item and service).

``(V) The percentage and number of specified requests that were denied during the previous plan year by the plan in an initial determination and that were subsequently appealed.

``(VI) The number of appeals of specified requests resolved during the preceding plan year, and the percentage and number of such resolved appeals that resulted in approval of the furnishing of the item or service that was the subject of such request, categorized by each applicable item and service and categorized by each level of appeal (including judicial review).

``(VII) The percentage and number of specified requests that were denied, and the percentage and number of specified requests that were approved, by the plan during the previous plan year through the utilization of decision support technology, artificial intelligence technology, machine- learning technology, clinical decision-making technology, or any other technology specified by the Secretary.

``(VIII) The average and the median amount of time (in hours) that elapsed during the previous plan year between the submission of a specified request to the plan and a determination by the plan with respect to such request for each such item and service, excluding any such requests that were not submitted with the medical or other documentation required to be submitted by the plan.

``(IX) The percentage and number of specified requests that were excluded from the calculation described in subclause (VIII) based on the plan's determination that such requests were not submitted with the medical or other documentation required to be submitted by the plan.

``(X) Information on each occurrence during the previous plan year in which, during a surgical or medical procedure involving the furnishing of an applicable item or service with respect to which such plan had approved a prior authorization request, the provider of services or supplier furnishing such item or service determined that a different or additional item or service was medically necessary, including a specification of whether such plan subsequently approved the furnishing of such different or additional item or service.

``(XI) A disclosure and description of any technology described in subclause (VII) that the plan utilized during the previous plan year in making determinations with respect to specified requests.

``(XII) The number of grievances (as described in subsection (f)) received by such plan during the previous plan year that were related to a prior authorization requirement.

``(XIII) Such other information as the Secretary determines appropriate.

``(ii) The plan shall provide--

``(I) to each provider or supplier who seeks to enter into a contract with such plan to furnish applicable items and services under such plan, the list described in clause (i)(I) and any policies or procedures used by the plan for making determinations with respect to prior authorization requests;

``(II) to each such provider and supplier that enters into such a contract, access to the criteria used by the plan for making such determinations and an itemization of the medical or other documentation required to be submitted by a provider or supplier with respect to such a request; and

``(III) to an enrollee of the plan, upon request, access to the criteria used by the plan for making determinations with respect to prior authorization requests for an item or service.

``(B) Option for plan to provide certain additional information.--As part of the information described in subparagraph (A)(i) provided to the Secretary during a plan year, a Medicare Advantage plan may elect to include information regarding the percentage and number of specified requests made with respect to an individual and an item or service that were denied by the plan during the preceding plan year in an initial determination based on such requests failing to demonstrate that such individuals met the clinical criteria established by such plan to receive such items or services.

``(C) Regulations.--The Secretary shall, through notice and comment rulemaking, establish requirements for Medicare Advantage plans regarding the provision of--

``(i) access to criteria described in subparagraph (A)(ii)(II) to providers of services and suppliers in accordance with such subparagraph; and

``(ii) access to such criteria to enrollees in accordance with subparagraph (A)(ii)(III).

``(D) Publication of information.--The Secretary shall publish information described in subparagraph (A)(i) and subparagraph (B) on a public website of the Centers for Medicare & Medicaid Services. Such information shall be so published on an individual plan level and may in addition be aggregated in such manner as determined appropriate by the Secretary.

``(E) Medpac report.--Not later than 3 years after the date information is first submitted under subparagraph (A)(i), the Medicare Payment Advisory Commission shall submit to Congress a report on such information that includes a descriptive analysis of the use of prior authorization. As appropriate, the Commission should report on statistics including the frequency of appeals and overturned decisions. The Commission shall provide recommendations, as appropriate, on any improvement that should be made to the electronic prior authorization programs of Medicare Advantage plans.

``(F) Specified request defined.--For purposes of this paragraph, the term `specified request' means a prior authorization request made with respect to an applicable item or service.

``(4) Enrollee protection standards.--For purposes of paragraph (1)(A)(ii), the Secretary shall, through notice and comment rulemaking, specify the following enrollee protection standards with respect to the use of prior authorization by Medicare Advantage plans for applicable items and services:

``(A) Adoption of transparent prior authorization programs developed in consultation with enrollees and with providers and suppliers with contracts in effect with such plans for furnishing such items and services under such plans;

``(B) Allowing for the waiver or modification of prior authorization requirements based on the performance of such providers and suppliers in demonstrating compliance with such requirements, such as adherence to evidence-based medical guidelines and other quality criteria; and

``(C) Conducting annual reviews of such items and services for which prior authorization requirements are imposed under such plans through a process that takes into account input from enrollees and from providers and suppliers with such contracts in effect and is based on consideration of prior authorization data from previous plan years and analyses of current coverage criteria.

``(5) Applicable item or service.--For purposes of this subsection, the term `applicable item or service' means, with respect to a Medicare Advantage plan, any item or service for which benefits are available under such plan, other than a covered part D drug.

``(6) Reports to congress.--

``(A) GAO.--Not later than the end of the fourth plan year beginning on or after the date of the enactment of this subsection, the Comptroller General of the United States shall submit to Congress a report containing an evaluation of the implementation of the requirements of this subsection and an analysis of issues in implementing such requirements faced by Medicare Advantage plans.

``(B) HHS.--Not later than the end of the fifth plan year beginning after the date of the enactment of this subsection, and biennially thereafter through the date that is 10 years after such date of enactment, the Secretary shall submit to Congress a report containing a description of the information submitted under paragraph (3)(A)(i) during--

``(i) in the case of the first such report, the fourth plan year beginning after the date of the enactment of this subsection; and

``(ii) in the case of a subsequent report, the 2 plan years preceding the year of the submission of such report.''.

(b) Ensuring Timely Responses for All Prior Authorization Requests Submitted Under Part C.--Section 1852(g) of the Social Security Act (42 U.S.C. 1395w-22(g)) is amended--

(1) in paragraph (1)(A), by inserting ``and in accordance with paragraph (6)'' after ``paragraph (3)'';

(2) in paragraph (3)(B)(iii), by inserting ``(or, subject to subsection (o), with respect to prior authorization requests submitted on or after the first day of the third plan year beginning after the date of the enactment of the Improving Seniors' Timely Access to Care Act of 2022, not later than 24 hours)'' after ``72 hours''.

(3) by adding at the end the following new paragraph:

``(6) Timeframe for response to prior authorization requests.--Subject to paragraph (3) and subsection (o), in the case of an organization determination made with respect to a prior authorization request for an item or service to be furnished to an individual submitted on or after the first day of the third plan year beginning after the date of the enactment of this paragraph, the organization shall notify the enrollee (and the physician involved, as appropriate) of such determination no later than 7 days (or such shorter timeframe as the Secretary may specify through notice and comment rulemaking, taking into account enrollee and stakeholder feedback) after receipt of such request.''. SEC. 3. FUNDING.

The Secretary of Health and Human Services shall provide for the transfer, from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act (42 U.S.C. 1395t) (in such proportion as determined appropriate by the Secretary) to the Centers for Medicare & Medicaid Services Program Management Account, of $25,000,000 for fiscal year 2022, to remain available until expended, for purposes of carrying out the amendments made by this Act.

Mr. Speaker, more than 28 million seniors get healthcare through Medicare Advantage, including 600,000 in Washington State.

For these seniors and the physicians that care for them, we must deliver a quality product that allows providers to keep our seniors as healthy as possible while reducing wait times, paperwork, and hassle.

Unfortunately, the cumbersome and antiquated prior authorization process that many Medicare Advantage plans utilize often gets in the way. This involves multiple phone calls and faxing documents to insurance companies. It is 2022, and even Congress has moved beyond faxing.

The HHS Inspector General recently reported that prior authorization is responsible for delaying and even denying medically necessary care. That mirrors reports that we have heard from providers for years now.

In one case, the inspector general found that, due to prior authorization, a 76-year-old Medicare beneficiary with post-polio syndrome was denied a request for a walker.

In another case, a Washington State resident and professional fisherman had to miss this past summer's fishing season in Alaska because his hip surgery was delayed for months.

According to the American Medical Association, one out of every four physicians report that prior authorization has led to a patient being hospitalized. Prior authorization is also a burden on providers, who spend 13 hours a week completing prior authorization paperwork, often for procedures that are approved over 95 percent of the time. That is time they could be spending with patients.

Today, the House of Representatives will take a major step forward in resolving this problem. The Improving Seniors' Timely Access to Care Act will make commonsense changes to prior authorization to ensure our seniors are getting the care they need when they need it.

First, the bill would require all plans to use an electronic prior authorization system. That means no more phone calls, no more faxes, and no more wondering what information is needed to submit to insurance plans when requesting prior authorization.

Second, we establish a process for real-time decisionmaking. It doesn't make sense that services in line with standard clinical practice guidelines or services that are approved more than 95 percent of the time are subject to prior authorization.

We also know that delayed approvals can result in patients falling through the cracks and missing out on care. Real-time decisions will help stop that.

Finally, this bill requires reporting on the number of prior authorization requests, the rates of approvals and denials, and the rates of successful appeals to increase transparency.

Collectively, this bill will help providers spend more time with patients and less time with paperwork.

Today's vote and the teamwork that brought this legislation to this moment is a bipartisan success story that shows that Congress can come together and put the needs of the American people before the gridlock that we all know too well.

Mr. Speaker, I thank Representative Mike Kelly, our Republican lead, for his tireless work on this for years, also our co-leads, Dr. Ami Bera and Larry Bucshon, as well as Senator Roger Marshall, who worked with us when he was in the House in the 116th Congress and has continued this effort in the Senate.

I thank the over 300 of my colleagues on both sides of the aisle who have cosponsored this bill. The support for this legislation has been overwhelming and it has been endorsed by over 500 healthcare organizations.

I particularly thank the Regulatory Relief Coalition and the American Medical Association that helped develop a quality bill and build support for it.

Mr. Speaker, I include in the Record a list of endorsements and the letters of support from the Regulatory Relief Coalition and the American Medical Association. The Improving Seniors' Timely Access to Care Act of 2021 (S. 3018/H.R. 3173) List of 500 Supporting Organizations (as of 7/6/2022) National Supporters

2020 Mom, ACCSES, Academy of Consultation-Liaison Psychiatry, Accuray, Inc., AdvaMed, Aimed Alliance, ALK Positive, Inc., Alliance for Aging Research, Alliance for Headache Disorders Advocacy, Alliance for Patient Access, Alliance of Specialty Medicine, ALS Association, Alzheimer's Association and Alzheimer's Impact movement, America's Physician Groups, American Academy of Allergy, Asthma & Immunology, American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology Association, American Academy of Emergency Medicine, American Academy of Family Physicians, American Academy of Hospice and Palliative Medicine, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology--Head and Neck Surgery, American Academy of PAs.

American Academy of Physical Medicine and Rehabilitation, American Academy of Sleep Medicine, American Association for Hand Surgery, American Association for Homecare, American Association for Marriage and Family Therapy, American Association for Pediatric Ophthalmology and Strabismus, American Association for Physician Leadership, American Association for Psychoanalysis in Clinical Social Work, American Association of Clinical Endocrinology, American Association of Clinical Urologists, American Association of Neurological Surgeons, American Association of Neuromuscular & Electrodiagnostic Medicine, American Association of Nurse Anesthetists, American Association of Orthopaedic Surgeons, American Association on Health and Disability, American Clinical Laboratory Association, American Clinical Neurophysiology Society, American College of Allergy, Asthma and Immunology, American College of Cardiology, American College of Emergency Physicians, American College of Gastroenterology, American College of Medical Genetics and Genomics, American College of Mohs Surgery, American College of Obstetricians and Gynecologists.

American College of Osteopathic Internists, American College of Osteopathic Surgeons, American College of Physicians, American College of Radiation Oncology, American College of Radiology, American College of Rheumatology, American College of Surgeons, American Counseling Association, American Epilepsy Society, American Foundation for Suicide Prevention, American Gastroenterological Association, American Geriatrics Society, American Glaucoma Society, American Group Psychotherapy Association, American Health Information Management Association, American Hospital Association, American Institute of Ultrasound in Medicine, American Medical Association, American Medical Rehabilitation Providers Association, American Medical Women's Association, American Mental Health Counselors Association, American Nurses Association, American Occupational Therapy Association, American Optometric Association, American Osteopathic Association, American Osteopathic College of Ophthalmology, American Physical Therapy Association, American Psychiatric Association, American Psychiatric Nurses Association, American Psychoanalytic Association, American Psychological Association, American Society for Clinical Pathology, American Society for Gastrointestinal Endoscopy.

American Society for Laser Medicine and Surgery, American Society for Radiation Oncology, American Society of Anesthesiologists, American Society of Breast Surgeons, American Society of Cataract and Refractive Surgery, American Society of Dermatopathology, American Society of Echocadiography, American Society of Hematology, American Society of Neuroradiology, American Society of Nuclear Cardiology, The American Society of Pain and Neuroscience, American Society of Plastic Surgeons, American Society of Retina Specialists, American Society of Transplant Surgeons, American Society of Transplant Surgeons (ASTS), American Society of Echocardiography, American Therapeutic Recreation Association, American Urogynecologic Society, American Urological Association, American Vein & Lymphatic Society, American Venous Forum, America's Essential Hospitals, Anxiety and Depression Association of America, Arthritis Foundation, Association for Ambulatory Behavioral Healthcare, Association for Clinical Oncology, Association of Academic Physiatrists, Association of Black Cardiologists, Association of Community Cancer Centers, Association of Freestanding Radiation Oncology Centers, Association of Mature American Citizens, Association of Rehabilitation Nurses, Association of University Professors of Ophthalmology.

Association of Women in Rheumatology, Better Medicare Alliance, Beyond Type 1, Boston Scientific, Brain Injury Association of America, Bridge the Gap--SYNGAP Education and Research Foundation, Cancer Support Community, CancerCare, Case Management Society of America, CHAMP--Coalition for Headache and Migraine Patients, Change Healthcare, Child Neurology Society, Children and Adults with Attention- Deficit/Hyperactivity Disorder, Chris CJ Johnson Foundation Inc., Christopher & Dana Reeve Foundation, Chronic Care Policy Alliance, Clinical Social Work Association, Coalition of Long-Term Acute-Care Hospitals, Cohere Health, College of Psychiatric and Neurologic Pharmacists, Community Liver Alliance, Community Oncology Alliance, Congress of Clinical Rheumatology, Congress of Neurological Surgeons, Consortium of Multiple Sclerosis Centers, Continuum Therapy Partners, Cooley's Anemia Foundation, Cornea Society, Corporation for Supportive Housing (CSH), Depression and Bipolar Support Alliance, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition.

Driven To Cure, Eating Disorders Coalition for Research, Policy & Action, Endocrine Society, Epic Systems, Epilepsy Foundation, Eye Bank Association of America, Falling Forward Foundation, Federation of American Hospitals, Ferrell Foundation, Free2Care, Global Alliance for Behavioral Health and Social Justice, Global Healthy Living Foundation, Global Liver Institute, GO2 Foundation for Lung Cancer, The Headache and Migraine Policy Forum, Healthcare Information and Management Systems Society, HealthPRO-Heritage, Hematology/ Oncology Pharmacy Association, Hyperemesis Education and Research Foundation, International Essential Tremor Foundation, International Foundation for Autoimmune & Autoinflammatory Arthritis, International OCD Foundation, Johnson & Johnson, Judy Nicholson Kidney Cancer Foundation, KCCure (Kidney Cancer Research Alliance), The Kennedy Forum, Kidney Cancer Association, KidneyCAN, Lakeshore Foundation, LeadingAge, The Leukemia & Lymphoma Society, Lupus and Allied Diseases Association, Inc.

Maternal Mental Health Leadership Alliance, Medical Device Manufacturers Association, Medical Group Management Association, Medical Oncology Association of Southern California, Mental Health America, The Michael J. Fox Foundation for Parkinson's Research, Multiple Sclerosis Association of America, NAADAC, the Association for Addiction Professionals, National Alliance of Safety-Net Hospitals, National Alliance on Mental Illness, National Association for Behavioral Healthcare, National Association for Children's Behavioral Health, National Association for Home Care & Hospice, National Association for the Advancement of Orthotics and Prosthetics, National Association for the Support of Long Term Care, National Association of ACOs, National Association of Epilepsy Centers, National Association of Rehab Providers & Agencies, National Association of Social Workers, National Association of Spine Specialists, National Association of State Head Injury Administrators, National Association of State Mental Health Program Directors, National Community Pharmacists Association, National Comprehensive Cancer Network, National Council for Mental Wellbeing, National Disability Rights Network, National Eating Disorders Association, National Federation of Families, National Hispanic Medical Association.

National Kidney Foundation, National League for Nursing, National Multiple Sclerosis Society, National Osteoporosis Foundation, National Patient Advocate Foundation, National Register of Health Service Psychologists, NHMH--No Health without Mental Health, Nomi Health, North American Neuro- Ophthalmology Society, OCHIN, Outpatient Ophthalmic Surgery Society, Pacific Spine & Pain Society, Partnership for Quality Home Healthcare, Patients Rising, Patients Rising Now, Physician Hospitals of America, Physicians Advocacy Institute, Postpartum Support International, Premier, Private Practice Section (PPS) of the American Physical Therapy Association (APTA), Prostate Network, Pulmonary Fibrosis Foundation, R.M.C. Inc., REDC Consortium, Regulatory Relief Coalition, Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), Remote Cardiac Services Providers Group, Renal Physicians Association, RetireSafe, SMART Recovery, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Magnetic Resonance, Society for Vascular Surgery.

Society of Cardiovascular Computed Tomography, Society of Gynecologic Oncology, Society of Hospital Medicine, Society of Interventional Radiology, The Society of Thoracic Surgeons, Spina Bifida Association, Spine Intervention Society, Susan G. Komen, Sterling Vision, Tourette Association of America, Treatment Communities of America, Triage Cancer, VHL Alliance, ZERO--The End of Prostate Cancer. state supporters

Medical Association of the State of Alabama, Alabama Academy of Ophthalmology, Alabama Association of Health Information Management, Alabama Cancer Congress, Alabama Chapter, American College of Surgeons, Alabama Society for the Rheumatic Diseases, Alaska Chapter, American College of Surgeons, The Arizona Clinical Oncology Society, Arizona Chapter, American College of Surgeons, Arizona Health Information Management Association, Arizona Neurosurgical Society, Arkansas Chapter, American College of Surgeons, Arkansas Medical Society, Arkansas Ophthalmological Society, Arkansas Orthopaedic Society, Arkansas Rheumatology Association, Association of Northern California Oncologists, Brooklyn-Long Island Chapter, American College of Surgeons, California Medical Association, California Academy of Eye Physicians and Surgeons, California Association of Neurological Surgeons, Medical Oncology Association of Southern California, Inc., Centura Health.

Colorado Chapter, American College of Surgeons, Colorado Medical Society, Colorado Society of Eye Physicians & Surgeons, Community Care Network of Kansas, Connecticut Chapter, American College of Surgeons, Connecticut Oncology Association, Connecticut State Medical Society, Medical Society of Delaware, Delaware Chapter, American College of Surgeons, Delaware Society for Clinical Oncology, Medical Society of the District of Columbia, Denali Oncology Group, DHR Health, Eastern Long Island Chapter, American College of Surgeons, Empire State Hematology and Oncology Society, Florida Medical Association, Florida Academy of Family Physicians, Florida Chapter, American College of Surgeons, Florida Health Information Management Association, Florida Neurosurgical Society, Florida Society of Clinical Oncology, The Florida Society of Neurology, Florida Society of Ophthalmology, Medical Association of Georgia, Georgia Neurological Society, Georgia Society of Clinical Oncology, Georgia Society of Ophthalmology.

Georgia Society of the American College of Surgeons, Guam Chapter, American College of Surgeons, Hawaii Medical Association, Hawaii Chapter, American College of Surgeons, Hawaii Society of Clinical Oncology, Idaho Medical Association, Idaho Chapter, American College of Surgeons, Illinois State Medical Society, Illinois Academy of Family Physicians, Illinois Chapter, American College of Surgeons, Illinois Medical Oncology Society, Illinois State Neurosurgical Society, Indiana State Medical Association, Indiana Academy of Ophthalmology, Indiana Chapter, American College of Surgeons, Indiana Neurological Society, Indiana Oncology Society, Iowa Chapter, American College of Surgeons, Iowa Medical Society, Iowa Oncology Society, Jacksonville Chapter, American College of Surgeons, Kansas Chapter, American College of Surgeons, Kansas Health Information Management Association, Kansas Hospital Association, Kansas Medical Society, Kansas Radiological Society, Kansas Society of Clinical Oncology.

Kentucky Medical Association, Kentucky Academy of Eye Physicians & Surgeons, Kentucky Chapter, American College of Surgeons, Kentucky Society of Clinical Oncology, Keystone Chapter, American College of Surgeons, Lake Plains Medical PLLC, Life Sciences Pennsylvania, Louisiana State Medical Society, Louisiana Academy of Family Physicians, Louisiana Chapter, American College of Surgeons, Louisiana Oncology Society, Maine Medical Association, Maine Chapter, American College of Surgeons, Maine Society of Eye Physicians and Surgeons, Maryland Chapter, American College of Surgeons, Maryland Society of Eye Physicians and Surgeons, Maryland/DC Society of Clinical Oncology, Massachusetts Chapter, American College of Surgeons, Massachusetts Health Information Management Association (MaHIMA), Massachusetts Medical Society, Massachusetts Society of Clinical Oncologists, Massachusetts Society of Eye Physicians & Surgeons, MedChi, The Maryland State Medical Society, Metropolitan Chicago Chapter, American College of Surgeons, Metropolitan Philadelphia Chapter, American College of Surgeons.

Metropolitan Washington DC Chapter, American College of Surgeons, Michigan Chapter, American College of Surgeons, Michigan Society of Hematology and Oncology, Michigan State Medical Society, Midwest Association for Medical Equipment Services & Supplies, MidWest Rheumatology Association, Minnesota Medical Association, Minnesota Academy of Ophthalmology, Minnesota Health Information Management Association, Minnesota Society of Clinical Oncology, Minnesota Surgical Society--a Chapter of the ACS, American College of Surgeons, Mississippi State Medical Association, Mississippi Chapter, American College of Surgeons, Mississippi Oncology Society, Missouri State Medical Association, Missouri Academy of Family Physicians, Missouri Chapter, American College of Surgeons, Missouri Oncology Society, Montana Medical Association, Montana Academy of Family Physicians, Montana and Wyoming Chapter, American College of Surgeons, Montana State Oncology Society, MSARS, Nebraska Medical Association, Nebraska Academy of Eye Physicians and Surgeons, Nebraska Chapter, American College of Surgeons, Nebraska Neurological Society.

Nebraska Oncology Society, Neurosurgical Society of the Virginias, Nevada State Medical Association, Nevada Chapter, American College of Surgeons, Nevada Health Information Management Association, Nevada Oncology Society, New Hampshire Medical Society, New Hampshire Chapter, American College of Surgeons, Medical Society of New Jersey, New Jersey Academy of Ophthalmology, New Jersey Chapter, American College of Surgeons, New Jersey Health Information Management Association, Medical Oncology Society of New Jersey, New Mexico Chapter, American College of Surgeons, New Mexico Medical Society, New Mexico Society of Clinical Oncology, Medical Society of the State of New York, New York Chapter, American College of Surgeons, New York State Academy of Family Physicians, New York State Neurosurgical Society, New York State Ophthalmological Society, North Carolina Chapter, American College of Surgeons, North Carolina Medical Society, North Carolina Oncology Association, North Carolina Society of Eye Physicians and Surgeons, North Dakota Medical Association, North Dakota Chapter, American College of Surgeons.

North Texas Chapter, American College of Surgeons, Northern California Chapter, American College of Surgeons, Northern New England Clinical Oncology Society, Northwestern Pennsylvania Chapter, American College of Surgeons, Ohio State Medical Association, Ohio Academy of Family Physicians, Ohio Association of Rheumatology, Ohio Chapter, American College of Surgeons, Ohio Health Information Management Association, Ohio Hematology Oncology Society Oklahoma State Medical Association, Oklahoma Chapter, American College of Surgeons, Oklahoma Society of Clinical Oncology Oregon Medical Association, Oregon Academy of Family Physicians, Oregon Academy of Ophthalmology, Oregon Chapter, American College of Surgeons, Oregon Society of Medical Oncology, Pennsylvania Medical Society, Pennsylvania Academy of Ophthalmology, Pennsylvania Chapter of the American College of Cardiology, Pennsylvania Medical Society, Pennsylvania Neurosurgical Society, Pennsylvania Rheumatology Society, Pennsylvania Society of Oncology & Hematology, The Hospital and Healthsystem Association of Pennsylvania, PHIMA.

Prodigy Rehabilitation Group, Inc., PT Northwest, Puerto Rico Chapter, American College of Surgeons, Puerto Rico Hematology and Medical Oncology Association, Rhode Island Chapter, American College of Surgeons, Rhode Island Health Information Management Association, Rhode Island Medical Society, Rhode Island Neurological Society, Rocky Mountain Oncology Society, San Diego Chapter, American College of Surgeons, Society of Utah Medical Oncologists, South Carolina Chapter, American College of Surgeons, South Carolina Oncology Society, South Dakota Academy of Ophthalmology, South Dakota Chapter, American College of Surgeons, South Florida Chapter, American College of Surgeons, South Texas Chapter, American College of Surgeons, Southern California Chapter, American College of Surgeons, Southwest Missouri Chapter, American College of Surgeons, Southwestern Pennsylvania Chapter, American College of Surgeons, Tennessee Medical Association, Tennessee Chapter, American College of Surgeons, Tennessee Oncology Practice Society, Texas Medical Association, Texas Academy of Family Physicians.

Texas Hospital Association, Texas Ophthalmological Association, Texas Society of Clinical Oncology, Transitional Care Management, Utah Medical Association, Utah Chapter, American College of Surgeons, Utah Ophthalmology Society, Vermont Chapter, American College of Surgeons, Vermont Medical Society, Medical Society of Virginia, Virginia Association of Hematologist & Oncologist, Virginia Chapter, American College of Surgeons, Virginia Society of Eye Physicians and Surgeons, Washington D.C. Metropolitan Ophthalmological Society, Washington State Medical Association, Washington Academy of Eye Physicians & Surgeons, Washington Academy of Family Physicians, Washington Chapter, American College of Surgeons, Washington State Association of Neurological Surgeons.

Washington Rheumatology Alliance, Washington State Medical Oncology Society, West Virginia Chapter, American College of Surgeons, West Virginia Oncology Society, West Virginia Orthopaedic Society, Western New York Chapter, American College of Surgeons, Wisconsin Medical Society, Wisconsin Academy of Ophthalmology, Wisconsin Association of Hematology & Oncology, Wisconsin Health Information Management Association, Wisconsin Hospital Association, Wisconsin Neurological Society, Wisconsin Rheumatology Association, Wisconsin Surgical Society--a Chapter of the ACS, The Woman's Group, Wyoming Medical Society, Wyoming State Oncology Society. ____ Regulatory Relief Coalition, September 12, 2022. Hon. Nancy Pelosi, Speaker, House of Representatives, Washington, DC. Hon. Kevin McCarthy, Republican Leader, House of Representatives, Washington, DC.

Dear Speaker Pelosi and Leader McCarthy: Members of the Regulatory Relief Coalition (RRC)--a group of national physician specialty organizations advocating for reduced regulatory burdens that interfere with patient care--thank you for scheduling a House floor vote on the Improving Seniors' Timely Access to Care Act on September 14, 2022.

This bipartisan bill is supported by more than 310 House co-sponsors and over 500 endorsing organizations representing patients, health care providers, medical technology and biopharmaceutical industry, health plans and others. The RRC's goal is to ensure that bureaucratic hurdles do not stand in the way of physicians providing medically necessary patient care.

The Improving Seniors' Timely Access to Care Act would improve prior authorization in the Medicare Advantage (MA) program by:

Establishing an electronic prior authorization (ePA) program;

Standardizing and streamlining the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions;

Ensuring prior authorization requests are reviewed by qualified medical personnel; and

Increasing transparency on MA prior authorization requirements and their use.

The RRC, which served as a lead stakeholder and key negotiator of the legislation, especially appreciates the tireless work of Reps. Suzan DelBene (D-WA), Mike Kelly (R- PA), Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) for their efforts leading up to this vote.

We urge the House to vote in favor of this critical legislation.

If you have any questions, please contact Peggy Tighe.

Thank you. Sincerely,

The Regulatory Relief Coalition, American Academy of Family Physicians, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Orthopaedic Surgeons, American Association of Neurological Surgeons, American College of Cardiology, American College of Rheumatology, American College of Surgeons, American Gastroenterological Association, American Osteopathic Association, Association For Clinical Oncology, Congress of Neurological Surgeons, Medical Group Management Association, National Association of Spine Specialists, Society for Cardiovascular Angiography & Interventions. ____ American Medical Association, September 13, 2022.

Hon. Nancy Pelosi, Speaker, House of Representatives, Washington, DC. Hon. Kevin McCarthy, Minority Leader, House of Representatives, Washington, DC.

Dear Speaker Pelosi and Ranking Member McCarthy: On behalf of the physician and medical student members of the American Medical Association (AMA), I write in strong support of H.R. 3173, the ``Improving Seniors' Timely Access to Care Act of 2022.'' This legislation, as originally introduced, garnered more than 300 bipartisan House cosponsors and the support of approximately 500 physician, hospital, patient, and insurer organizations. We greatly appreciate the House of Representatives scheduling a vote on this bipartisan legislation, which was favorably reported out of the Ways and Means Committee in July, and strongly urge swift passage to help streamline, simplify, and standardize prior authorization processes within Medicare Advantage (MA) plans.

Prior authorization, which is the practice by insurance companies of reviewing and potentially denying medical services and pharmaceuticals prior to treatment, remains a principal frustration for patients and physicians. This utilization management policy is overused, costly, opaque, burdensome to physicians, and harmful to patients due to delays in care.

AMA data compiled from annual surveys of more than l,000 practicing physicians continue to illustrate the negative impact of prior authorization policies. In fact, 34 percent of physicians who participated in a 2021 AMA survey reported that prior authorization led to a serious adverse event, such as hospitalization, disability, permanent bodily damage, or even death, for a patient in their care. The 2021 survey also highlights that 93 percent of physicians reported care delays associated with prior authorization, while 82 percent of respondents cited that these requirements can at least sometimes lead to patients abandoning treatments.

In addition, research from the federal government demonstrates that prior authorization leads to delays in patient care and inappropriate denials of medically necessary services. A 2018 report from the Department of Health and Human Services (HHS) Office of Inspector General (OIG) concluded that, between 2014 and 2016, MA plans overturned 75 percent oftheir own prior authorization and payment denials when appealed by providers and beneficiaries. An April 2022 HHS OIG report also found that 13 percent of prior authorization requests denied by MA plans met Medicare coverage rules, and 18 percent of payment request denials met Medicare and MA billing rules.

We commend the House of Representatives for working in a bipartisan fashion to develop an amended version of the Improving Seniors' Timely Access to Care Act. The modified legislation retains the crux of the original bill, the ``Improving Seniors' Timely Access to Care Act of 2021,'' including mandating that MA plans implement electronic prior authorization programs that adhere to new standards adopted by the federal government. This will help ensure that physicians are no longer forced to resort to faxes and e- forms, or even disparate, proprietary portals that fail to comply with these newly developed standards, when seeking to complete prior authorization requests. In addition, the provisions requiring robust data reporting, such as the number and percentage of prior authorization requests approved, denied, or approved upon appeal, will bring much needed transparency to ensure MA prior authorization programs are not inappropriately denying medically necessary care to patients and overburdening physicians with unnecessary requirements.

Most importantly, the additional sections of the legislation mandating MA plans to issue faster prior authorization decisions are crucial policy improvements that will ensure more timely access to care and, as a result, improve patient health care outcomes and better stewardship of scarce Medicare resources. The AMA supports the requirements for health plans to provide real-time prior authorization decisions for routinely approved services, as defined in implementing regulations. We also appreciate that the bill directs MA plans unable to meet the real-time processing requirement in the event of ``extenuating circumstances'' to issue final prior authorization decisions within a 72-hour and 24-hour timeline for regular and emergent services, respectively. Notably, the legislation requires MA plans to report the number of prior authorizations subject to this exception, providing the transparency needed to deter abuse of this provision.

In addition, we sincerely appreciate the inclusion of provisions pertaining to more timely prior authorization decisions for all other services within Medicare Part C. Requiring MA plans to issue final decisions within 24 hours for emergent services and no later than seven days after receipt of regular prior authorization requests is a vast improvement over current MA program practices. The expedited timelines for MA plans to issue final prior authorization decisions, both for routinely approved care and all other services, will undoubtedly lessen the burden on physicians, and, most significantly, ensure timely patient care and improved health outcomes.

The AMA is proud to support the Improving Seniors' Timely Access to Care Act. We commend the House of Representatives for voting on this legislation and stand ready to work to ensure bipartisan passage by the Senate. Sincerely, James L. Madara, MD.

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Ms. DelBENE. Mr. Speaker, I also thank the staff from the personal offices and from the committee and leadership offices that have spent countless hours researching this issue and working with stakeholders to develop this legislation.

In particular, I thank my former legislative director, Kyle Hill, who was truly integral in developing and advancing this legislation.

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Ms. DelBENE. Chu), my colleague on the Ways and Means Committee, another leader of this legislation.

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Ms. DelBENE. Mr. Speaker, it is so important that we work with experts in the medical community to develop strong legislation, and we are incredibly fortunate to have as one of our co-leads on this bill one of our doctors in Congress, so I want to thank him for all of his incredible work getting us to where we are today.

I yield 3 minutes to the gentleman from California (Mr. Bera).

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Ms. DelBENE. Mr. Speaker, I think it is past time for us to help our seniors get timely care. It is past time to help our medical professionals, our doctors, our nurses, and others who are burdened with undue paperwork, to help them spend more time providing care. It is past time for us to move a strong piece of legislation that has strong bipartisan support.

I thank Chairman Neal and everyone who has helped bring this legislation forward, folks on the Ways and Means Committee, including my colleague Mr. Kelly.

Mr. Speaker, I urge all of my colleagues to support this legislation, an incredible piece of work.

Congress of the United States, House of Representatives, Washington, DC, September 14, 2022.

Mr. Blumenauer: Mr. Speaker, I am pleased to support this important legislation to protect seniors' access to care in the Medicare Advantage program.

As many of you know, I have been a longtime champion of Medicare Advantage, and it's enjoyed tremendous popularity in Oregon. I believe that the way traditional fee-for-service Medicare operates is not sustainable and that Medicare Advantage is one of the tools we can use to demonstrate how we can incentivize value.

But this is only possible when the program operates as intended. I have been deeply concerned about the reports of delays in care, not only from the Inspector General, but from the constituents that come into my office. For patients and their families, being told that you need to wait longer for care that your doctor tells you that you need is incredibly frustrating and frightening. There's no comfort to be found in the fact that your insurance company needs time to decide if your doctor is right. For providers, the burden of prior authorization is immense. And at a time where we consistently hear that our health care workers are facing incredible burnout and are leaving the profession in alarming rates, it's critical that we remove unnecessary processes.

There is no reason that patients should be waiting for medically appropriate care especially when we know that this can lead to worse outcomes. The fundamental promise of Medicare Advantage is undermined when people are delaying care, getting sicker, and ultimately costing Medicare more money.

The legislation we are taking up today is commonsense policy that moves us towards the goals of the program and protects our patients and providers from unnecessary roadblocks to care. I want to commend Congresswoman DelBene for her leadership on this issue and I look forward to supporting this bipartisan legislation.

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