U.S. House of Representatives Passes Legislation to Streamline Prior Authorization in the Medicare Advantage Program

Members & Publications


September 14, 2022

We are thrilled to share that today, the U.S. House of Representatives passed the Improving Seniors’ Timely Access to Care Act (HR 3173/S 3018)! Thank you to all Academy members who reached out to members of Congress to ask for their vote in favor of this important legislation!

AAPM&R has long prioritized prior authorization reform in Medicare Advantage plans and supported the bipartisan Improving Seniors’ Timely Access to Care Act since its introduction in 2019 and helped the bill’s introduction to the 116th and 117th Congresses. We have advocated for this legislation during multiple Hill Day events, numerous grassroots campaigns and letters to Congress. To further advance these efforts, we joined the Regulatory Relief Coalition (RRC), a group of national physician specialty organizations advocating for regulatory burden reduction in Medicare so that physicians can spend more time treating patients.

“AAPM&R applauds the U.S. House of Representatives for taking steps to reform the use of prior authorization that is increasing barriers to care for patients, including those in need of rehabilitation. As more enrollees, especially seniors and individuals with disabilities, choose Medicare Advantage for their health insurance needs, it is crucial that prior authorization is not a barrier to access. Data from the Medicare Payment Advisory Commission (MedPAC) demonstrate that Medicare Advantage beneficiaries receive one-third the access to inpatient rehabilitation facilities (IRFs) that traditional Medicare beneficiaries receive. We are hopeful that the advancement of this legislation will streamline the process and increase transparency to prevent patients from receiving unnecessary delays and denials to the timely and medically necessary treatment they deserve.” – Deborah Venesy, MD, FAAPMR, AAPM&R President

Introduced by Representative Suzan DelBene (D-WA) and more than 320 co-sponsors, this bipartisan legislation will 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. Additionally, it will:

  • Establish an electronic prior authorization (ePA) program
  • Standardize and streamline the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions
  • Ensure prior authorization requests are reviewed by qualified medical personnel
  • Increase transparency around MA prior authorization requirements and their use

We encourage you to watch for future advocacy calls to action from the Academy as this legislation now moves to the Senate. The Academy will continue our targeted advocacy efforts to protect patients from unnecessary delays in care.

To learn more about our advocacy efforts, visit aapmr.org/advocacy.

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.