Prior Authorization Reform Bill Moving Advancing in Congress

The Improving Seniors’ Timely Access to Care Act – a top legislative priority for the American Academy of Ophthalmology (AAO) – recently cleared a key step in the legislative process, as the House Ways and Means Committee voted unanimously to advance the bill, which aims to reform prior authorization in Medicare Advantage plans.

The legislation, which would streamline and standardize prior authorization in the Medicare Advantage program, is now one step closer to consideration by the full U.S. House of Representatives. If passed by the full House, the bill will then move to the U.S. Senate for further consideration.

Providing much-needed oversight and transparency while protecting beneficiaries from unnecessary care delays and denials, the bill would require Medicare Advantage plans to:

• Establish an electronic prior authorization program.
• Standardize and streamline the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions.
• Ensure prior authorization requests are reviewed by qualified medical personnel.
• Increase transparency around Medicare Advantage prior authorization requirements and their use.

The AAO is actively advocating in Congress for swift passage of the bill.