New Cost Estimate Improves Chances for Prior Authorization Legislation

ASNC has supported the Improving Seniors’ Timely Access to Care Act (H.R. 3173) since the bill was introduced in 2021, as its provisions would streamline prior authorization requirements. Prospects for a previous version of the bill were blunted in 2022, when the Congressional Budget Office (CBO) reported the cost of the bill would be $16.2 billion dollars over 10 years. The Centers for Medicare & Medicaid Services (CMS) subsequently developed regulations that mimicked provisions of H.R. 3173. ASNC commented in support of CMS’s efforts to streamline the use of prior authorization in federal programs.

A bipartisan group of legislators in the House of Representatives has reintroduced the Improving Seniors’ Timely Access to Care Act as H.R. 8702. Senators Roger Marshall (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), and Sherrod Brown (D-OH) also reintroduced a version of the bill in the Senate.

House members revised some of the earlier bill’s costlier provisions toward budget neutrality. For example, the revised legislation would require Medicare Advantage plans to report their approval and denial rates; develop electronic prior authorization to streamline approvals; and encourage adherence to evidence-based guidelines. Reports indicate the CBO is unofficially telling legislators’ offices that the expected cost of the new version of the bill is budget neutral.

Use ASNC’s Action Center to contact your members of Congress. Tell them to streamline prior authorization by supporting the Improving Seniors’ Timely Access to Care Act.

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