This week, Congress called on CMS to finalize long-overdue key prior authorization reforms. 233 members of the House and 61 Senators sent letters calling for a prompt update to a rule proposed at the end of 2022 that would require Medicare Advantage insurers to update their archaic and burdensome prior auth processes. As part of Advocacy Day and beyond, ASTRO worked with health care partners to encourage Members of Congress to sign the letters. A copy of the letters may be found here.

Why it matters: Lawmakers are urging the Administration to ensure final rules fall in line with the Improving Seniors Timely Access to Care bill, which passed the House unanimously and garnered majority support in the Senate. ASTRO, along with over 500 other health care organizations, endorsed this legislation.

Going Deeper: Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera (CA-06) and Larry Bucshon (IN-08), in partnership with Senators John Thune (SD), Sherrod Brown (OH), Roger Marshall, M.D. (KS), and Kyrsten Sinema (AZ), again called on CMS to reduce Medicare Advantage’s burdensome, harmful prior auth requirements and increase transparency. Last December, CMS proposed prior auth reforms, but key provisions that would ensure seniors receive quality care and would greatly reduce the burden on providers were excluded. Lawmakers are urging Medicare officials to enhance current proposals by including real-time electronic decisions for routinely approved services, requiring faster turnaround time for urgently needed treatment decisions from three days to 24 hours, and increasing transparency so providers may better understand insurers’ restrictions and requirements.

Next steps: CMS is under no timeline to finalize the rules they proposed over six months ago, but lawmakers and hundreds of physician groups – including ASTRO – are urging action before the end of this year.