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Capitol Hill Report: Help Act to Increase Transparency and Streamline Prior Authorization

June 21, 2021

Latest Advocacy News

  • On June 17, the Supreme Court dismissed a challenge to the Affordable Care Act, leaving the law intact. The lawsuit was brought by a group of states led by Texas, arguing that the law was now unconstitutional due to a change in 2017 eliminating the financial penalty for not having health insurance.
  • The AAN sent a letter of endorsement for the COVID-19 Long Haulers Act (H.R. 2754), a bipartisan bill to support education and research efforts on long-term symptoms of COVID-19.
  • The AAN recently re-endorsed the Conrad State 30 and Physician Access Reauthorization Act (S. 1810/H.R. 3541), a bipartisan bill to support the Conrad 30 program, which allows international doctors to stay in the US after their residency if they practice in an underserved area for three years.
  • At the American Medical Association’s recent June Special Meeting, its House of Delegates passed new policy to: maintain access to telehealth post-pandemic, advocate for research funding for long COVID, oppose insurer policies that offer financial incentives to patients to switch treatments, improve rates of advance care planning, and advocate for increased flexibility on information-blocking rules.

Issue In Focus

Last week, more than 1,500 AAN members participated in a week of action dedicated to bipartisan legislation that aims to increase transparency and streamline prior authorization (PA) in the Medicare Advantage (MA) program. The bill, H.R. 3173, the Improving Seniors’ Timely Access to Care Act of 2021, was introduced in the House by Reps. Suzan DelBene (D-WA) and Mike Kelly (R-PA), both of whom serve on the important Ways and Means Committee which oversees this issue, along with 89 other original cosponsors. The bill comes with the strong endorsement from the Regulatory Relief Coalition, of which the AAN is a member. As a result of AAN member’s efforts, three new members have signed on to the legislation, our voice was further amplified on Capitol Hill, and the call for regulatory reform was heard.

Specifically, H.R. 3173 would improve MA prior authorization by:

  • Establishing an electronic prior authorization (ePA) program and requiring MA plans to adopt ePA capabilities
  • Requiring the secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program
  • Standardizing and streamlining the PA process for routinely approved items and services
  • Ensuring PA requests are reviewed by qualified medical personnel
  • Increasing transparency around MA PA requirements and their use
  • Protecting beneficiaries from any disruptions in care due to PA requirements as they transition between MA plans

This legislation was also introduced in the last Congress and had support from over 280 members of Congress but consideration of the measure was delayed as a result of the pandemic. To accomplish the objectives of streamlining prior authorization process and increasing transparency, we ask that you take action if you have not already.

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