Congressional Prior Authorization Reform Leads Applaud New HHS & CMS Announcement

WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA) and Roger Marshall (R-KS) and U.S. Reps. Mike Kelly (PA-16), Suzan DelBene (WA-01), John Joyce, M.D. (PA-13), and Ami Bera, M.D. (CA-06), co-leads of the bipartisanImproving Seniors’ Timely Access to Care Act, released the following joint statement after an announcement Monday from U.S. Health & Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid (CMS) Administrator Dr. Mehmet Oz thatpledgesto ease the Medicare Advantage prior authorization process.
The pledge, which includes several provisions contained in their legislation, follows years of legislative progress led by Kelly and Congressional colleagues.
“We applaud these commitments, which aims to improve health care access for millions of Americans by easing the Medicare Advantage prior authorization process,” the Members said. “We encourage our House and Senate colleagues to carry this momentum forward and to pass our life-changing legislation, theImproving Seniors’ Timely Access to Care Act, to ensure this progress becomes law.”
Under the commitment, participating health plans would:
In May 2025, Sen. Warner reintroducedthe Improving Seniors’ Timely Access to Care Act.Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. But it’s not without fault. The current system often results in unconfirmed faxes of a patient’s medical information or phone calls by clinicians which takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers, andthree out of fourMedicare Advantage enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS)raised concernsafter an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS OIGreleased a reportfinding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.
Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.Specifically, the legislation would:
Text of the bill can be foundhereand a section-by-section can be foundhere.