The American Society of Nuclear Cardiology (ASNC) has endorsed bipartisan legislation pending in the U.S. Senate and House that would address one of the most administratively burdensome and costly issues for physicians — prior authorization (PA). 

The Improving Seniors’ Timely Access to Care Act (S. 1816 / H.R. 3514) will tackle the overuse and abuse of PA by Medicare Advantage (MA) plans, which threaten access to medically necessary care and increase provider administrative burden. The bill would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes rule, which was finalized by the Centers for Medicare & Medicaid Services on Jan. 17, 2024. 

Lawmakers need to hear from you, their constituents, about why prior authorization reform is important for your practice and your patients. 

Specifically, the legislation:

• Establishes an electronic prior authorization process for MA plans, including standardization of transactions and clinical attachments.
• Increases transparency around MA prior authorization requirements and their use.
• Provides a pathway for CMS to institute real-time decisions for routinely approved items and services in the future and clarifies CMS’ authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services and any other PA request.
• Expands beneficiary protections to improve enrollee experiences and outcomes.
• Requires the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to improve the e-PA process.

ASNC also supports the Reducing Medically Unnecessary Delays in Care Act of 2025 (H.R. 2433). This bill builds on current regulations by requiring all preauthorizations and adverse determinations be made by a licensed, board-certified physician who “typically manages the medical condition or disease or provides the health care service.”  It also aims to ensure that decisions about the medical necessity or appropriateness of health care services are made based on sound clinical evidence and involve input from actively practicing physicians.

Take action by telling your members of Congress why prior authorization reform is urgently needed.