Corneal Physician Bulletin: Prior Authorization Relief Bill Positioned for Passage

            Over one-half of the U.S. House of Representatives have co-sponsored the “Improving Seniors’ Timely Access to Care Act of 2021 (H.R. 3173)” placing it in position for passage in Congress, according to the American Academy of Ophthalmology.
            “Our patients simply can’t wait when their vision is at stake,” explains George A. Williams, MD, Senior Secretary for Advocacy of the American Academy of Ophthalmology. “Improving Seniors’ Timely Access to Care Act is the right relief at the right time. Our champions are taking us to a place where unnecessary barriers to necessary care will be a thing of the past.”
            Specifically, H.R. 3173, championed by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, MD, (D-CA), and Larry Bucshon, MD, (R-IN), is designed to thwart the needless lag in care associated with prior authorization by:
            • Establishing an electronic prior authorization (ePA) program and requiring Medicare Advantage (MA) plans to adopt ePA capabilities. 
            • Requiring the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program.
            • Standardizing and streamlining the prior authorization process for routinely approved items and services. 
            • Ensuring prior authorization requests are reviewed by qualified medical personnel.
            • Increasing transparency around MA prior authorization requirements and their use.
            • Protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
            This past July, health insurance company Aetna required prior authorizations for all cataract surgeries, citing its research showed as many as 20% of cataract surgeries are unnecessary. Aetna stated the policy was intended “to support [ophthalmologists in Aetna’s network] in preventing unnecessary surgeries and potential harm to [its] members.” CP