GOP Doctors Caucus Endorses Legislation to Improve Transparency and Expedite Patient Access to Care
Washington, D.C. - Today, the GOP Doctors Caucus announces its endorsement of H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act and H.R. 3514, the Seniors Timely Access to Care Act. These bipartisan pieces of legislation improve the timeliness, credibility, and transparency of prior authorization decisions for Medicare and Medicare Advantage beneficiaries.
"Prior authorization has become a harmful obstacle that stands in the way of patients receiving care recommended by their physician," said Co-Chairs Greg Murphy, M.D. & John Joyce, M.D. "Not only is this process abused by insurers to withhold coverage, but individuals without requisite expertise are executing denials. Doctors advocating on behalf of a patient should be aligned with someone of the same medical specialty or subspecialty who can intimately understand the complexities influencing their judgment. These pieces of legislation put patients first, empower physicians, and ensure that prior authorization cannot be used to deny care."
Background
H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act, would reform the practice of prior authorization in Medicare and Medicare Advantage by requiring that board-certified physicians in the same specialty are the ones making these important decisions. It also would direct Medicare, Medicare Advantage, and Medicare Part D plans to comply with requirements that restrictions must be based on medical necessity and written clinical criteria, as well as additional transparency obligations.
HR. 3514, the Seniors’ Timely Access to Care Act, would establish an electronic prior authorization process for Medicare Advantage plans, increase transparency around prior authorization requirements and usage, and clarify HHS’ authority on timeframes including expedited determinations. Additionally, this legislation would expand Medicare beneficiary protections and improve enrollee experiences and outcomes.