Lawmakers Support CMS Rules to Streamline Prior Authorizations

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

The Centers for Medicare & Medicaid Services (CMS) announced the draft rule in December 2022 with 5 key provisions and 5 requests for information. If implemented, CMS estimated the changes would save physicians and hospitals more than $15 billion over a 10-year period.

Medical organizations hammered Congress in the fall of 2022 to pass the Improving Seniors’ Timely Access to Care Act, a bill that would make it easier for older patients to get care by modernizing the prior authorization process. The US House of Representatives passed the legislation in September 2022, and as of press time, it remained pending in the Senate.

The CMS action would bring that legislation closer to reality, bill cosponsor Republican Senator Roger “Doc” Marshall, MD, of Kansas, said. 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.”

Marshall, an obstetrician-gynecologist, cited his experiences and challenges to patient care as a physician and hospital manager 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 also had comments from House and Senate cosponsors including Representatives Suzan DelBene (D, Washington); Ami Bera, MD (D, California); Larry Bucshon, MD (R, Indiana); and Mike Kelly (R, Pennsylvania) and Senators Kyrsten Sinema (I, Arizona); John Thune (R, South Dakota), and Sherrod Brown (D, Ohio).

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