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Citing lack of progress, physicians call on Congress to address prior authorization reform

Press releases may be edited for formatting or style | May 14, 2021 Insurance

This bipartisan legislation would require Medicare Advantage (MA) plans to implement a streamlined electronic prior authorization process that complies with technical standards developed by the Department of Health and Human Services, in consultation with relevant stakeholders. In addition, the bill would require increased transparency for beneficiaries and providers, as well as enhance oversight by the Centers for Medicare & Medicaid Services on the processes used for prior authorization. Moreover, to ensure that routinely approved care and treatments are not subjected to unnecessary delays, the program would provide for real-time decisions by an MA plan with respect to certain prior authorization requests. Importantly, the bill would also require MA plans to meet beneficiary protection standards, such as ensuring continuity of care when patients change plans.

The AMA strongly supports the Improving Seniors' Timely Access to Care Act. The data released today build upon previously published survey results that underscore the significant patient and practice burdens associated with prior authorization and the critical need for legislative reform.

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"There is no room in the patient-physician relationship for insurance-industry barriers. The AMA is dedicated to simplifying and right-sizing prior authorization so physicians can properly provide care and patients can receive the timely treatment they deserve," Bailey said. "This legislation is a win-win for patients and physicians."


About the AMA
The American Medical Association is the physicians' powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises, and, driving the future of medicine to tackle the biggest challenges in health care.

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