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Medical Group Management Association

September 9, 2019: MGMA joins 370 stakeholders calling for prior authorization reform

Advocacy Letter - September 9, 2019

Health Information Technology

September 9, 2019 
 
Dear Members of Congress: 
 
The undersigned patient, physician, health care professional, and other health care stakeholder organizations strongly support the Improving Seniors’ Timely Access to Care Act of 2019 (H.R. 3107) recently introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS), and Ami Bera, MD (D-CA).  This bipartisan legislation would help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors.  We urge you to join your colleagues in supporting this important legislation. 
 
Based on a consensus statement on prior authorization reform adopted by leading national organizations representing physicians, medical groups, hospitals, pharmacists, and health plans, the legislation would facilitate electronic prior authorization, improve transparency for beneficiaries and providers alike, and increase Centers for Medicare & Medicaid Services (CMS) oversight on how Medicare Advantage plans use prior authorization.  Specifically, the bill would: 
  • Create an electronic prior authorization program including the electronic transmission of prior authorization requests and responses and a real-time process for items and services that are routinely approved;
  • Improve transparency by requiring plans to report to CMS on the extent of their use of prior authorization and the rate of approvals or denials; 
  • Require plans to adopt transparent prior authorization programs that are reviewed annually, adhere to evidence-based medical guidelines, and include continuity of care for individuals transitioning between coverage policies to minimize any disruption in care;    
  • Hold plans accountable for making timely prior authorization determinations and to provide rationales for denials; and
  • Prohibit additional prior authorization for medically-necessary services performed during a surgical or invasive procedure that already received, or did not initially require, prior authorization.

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