[Congressional Record Volume 168, Number 148 (Wednesday, September 14, 2022)]
[House]
[Pages H7796-H7804]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          IMPROVING SENIORS' TIMELY ACCESS TO CARE ACT OF 2022

  Ms. DelBENE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3173) to amend title XVIII of the Social Security Act to 
establish requirements with respect to the use of prior authorization 
under Medicare Advantage plans, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3173

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Improving Seniors' Timely 
     Access to Care Act of 2022''.

     SEC. 2. ESTABLISHING REQUIREMENTS WITH RESPECT TO THE USE OF 
                   PRIOR AUTHORIZATION UNDER MEDICARE ADVANTAGE 
                   PLANS.

       (a) In General.--Section 1852 of the Social Security Act 
     (42 U.S.C. 1395w-22) is amended by adding at the end the 
     following new subsection:
       ``(o) Prior Authorization Requirements.--
       ``(1) In general.--In the case of a Medicare Advantage plan 
     that imposes any prior authorization requirement with respect 
     to any applicable item or service (as defined in paragraph 
     (5)) during a plan year, such plan shall--
       ``(A) beginning with the third plan year beginning after 
     the date of the enactment of this subsection--
       ``(i) establish the electronic prior authorization program 
     described in paragraph (2); and
       ``(ii) meet the enrollee protection standards specified 
     pursuant to paragraph (4); and
       ``(B) beginning with the fourth plan year beginning after 
     the date of the enactment of this subsection, meet the 
     transparency requirements specified in paragraph (3).
       ``(2) Electronic prior authorization program.--
       ``(A) In general.--For purposes of paragraph (1)(A), the 
     electronic prior authorization program described in this 
     paragraph is a program that provides for the secure 
     electronic transmission of--
       ``(i) a prior authorization request from a provider of 
     services or supplier to a Medicare Advantage plan with 
     respect to an applicable item or service to be furnished to 
     an individual and a response, in accordance with this 
     paragraph, from such plan to such provider or supplier; and
       ``(ii) any attachment relating to such request or response.
       ``(B) Electronic transmission.--
       ``(i) Exclusions.--For purposes of this paragraph, a 
     facsimile, a proprietary payer

[[Page H7797]]

     portal that does not meet standards specified by the 
     Secretary, or an electronic form shall not be treated as an 
     electronic transmission described in subparagraph (A).
       ``(ii) Standards.--An electronic transmission described in 
     subparagraph (A) shall comply with--

       ``(I) applicable technical standards adopted by the 
     Secretary pursuant to section 1173; and
       ``(II) other requirements to promote the standardization 
     and streamlining of electronic transactions under this part 
     specified by the Secretary.

       ``(iii) Deadline for specification of additional 
     requirements.--Not later than July 1, 2023, the Secretary 
     shall finalize requirements described in clause (ii)(II).
       ``(C) Real-time decisions.--
       ``(i) In general.--Subject to clause (iv), the program 
     described in subparagraph (A) shall provide for real-time 
     decisions (as defined by the Secretary in accordance with 
     clause (v)) by a Medicare Advantage plan with respect to 
     prior authorization requests for applicable items and 
     services identified by the Secretary pursuant to clause (ii) 
     if such requests are submitted with all medical or other 
     documentation required by such plan.
       ``(ii) Identification of items and services.--

       ``(I) In general.--For purposes of clause (i), the 
     Secretary shall identify, not later than the date on which 
     the initial announcement described in section 
     1853(b)(1)(B)(i) for the third plan year beginning after the 
     date of the enactment of this subsection is required to be 
     announced, applicable items and services for which prior 
     authorization requests are routinely approved.
       ``(II) Updates.--The Secretary shall consider updating the 
     applicable items and services identified under subclause (I) 
     based on the information described in paragraph (3)(A)(i) (if 
     available and determined practicable to utilize by the 
     Secretary) and any other information determined appropriate 
     by the Secretary not less frequently than biennially. The 
     Secretary shall announce any such update that is to apply 
     with respect to a plan year not later than the date on which 
     the initial announcement described in section 
     1853(b)(1)(B)(i) for such plan year is required to be 
     announced.

       ``(iii) Request for information.--The Secretary shall issue 
     a request for information for purposes of initially 
     identifying applicable items and services under clause 
     (ii)(I).
       ``(iv) Exception for extenuating circumstances.--In the 
     case of a prior authorization request submitted to a Medicare 
     Advantage plan for an individual enrolled in such plan during 
     a plan year with respect to an item or service identified by 
     the Secretary pursuant to clause (ii) for such plan year, 
     such plan may, in lieu of providing a real-time decision with 
     respect to such request in accordance with clause (i), delay 
     such decision under extenuating circumstances (as specified 
     by the Secretary), provided that such decision is provided no 
     later than 72 hours after receipt of such request (or, in the 
     case that the provider of services or supplier submitting 
     such request has indicated that such delay may seriously 
     jeopardize such individual's life, health, or ability to 
     regain maximum function, no later than 24 hours after receipt 
     of such request).
       ``(v) Definition of real-time decision.--In establishing 
     the definition of a real-time decision for purposes of clause 
     (i), the Secretary shall take into account current medical 
     practice, technology, health care industry standards, and 
     other relevant information relating to how quickly a Medicare 
     Advantage plan may provide responses with respect to prior 
     authorization requests.
       ``(vi) Implementation.--The Secretary shall use notice and 
     comment rulemaking for each of the following:

       ``(I) Establishing the definition of a `real-time decision' 
     for purposes of clause (i).
       ``(II) Updating such definition.
       ``(III) Initially identifying applicable items or services 
     pursuant to clause (ii)(I).
       ``(IV) Updating applicable items and services so identified 
     as described in clause (ii)(II).

       ``(3) Transparency requirements.--
       ``(A) In general.--For purposes of paragraph (1)(B), the 
     transparency requirements specified in this paragraph are, 
     with respect to a Medicare Advantage plan, the following:
       ``(i) The plan, annually and in a manner specified by the 
     Secretary, shall submit to the Secretary the following 
     information:

       ``(I) A list of all applicable items and services that were 
     subject to a prior authorization requirement under the plan 
     during the previous plan year.
       ``(II) The percentage and number of specified requests (as 
     defined in subparagraph (F)) approved during the previous 
     plan year by the plan in an initial determination and the 
     percentage and number of specified requests denied during 
     such plan year by such plan in an initial determination (both 
     in the aggregate and categorized by each item and service).
       ``(III) The percentage and number of specified requests 
     submitted during the previous plan year that were made with 
     respect to an item or service identified by the Secretary 
     pursuant to paragraph (2)(C)(ii) for such plan year, and the 
     percentage and number of such requests that were subject to 
     an exception under paragraph (2)(C)(iv) (categorized by each 
     item and service).
       ``(IV) The percentage and number of specified requests 
     submitted during the previous plan year that were made with 
     respect to an item or service identified by the Secretary 
     pursuant to paragraph (2)(C)(ii) for such plan year that were 
     approved (categorized by each item and service).
       ``(V) The percentage and number of specified requests that 
     were denied during the previous plan year by the plan in an 
     initial determination and that were subsequently appealed.
       ``(VI) The number of appeals of specified requests resolved 
     during the preceding plan year, and the percentage and number 
     of such resolved appeals that resulted in approval of the 
     furnishing of the item or service that was the subject of 
     such request, categorized by each applicable item and service 
     and categorized by each level of appeal (including judicial 
     review).
       ``(VII) The percentage and number of specified requests 
     that were denied, and the percentage and number of specified 
     requests that were approved, by the plan during the previous 
     plan year through the utilization of decision support 
     technology, artificial intelligence technology, machine-
     learning technology, clinical decision-making technology, or 
     any other technology specified by the Secretary.
       ``(VIII) The average and the median amount of time (in 
     hours) that elapsed during the previous plan year between the 
     submission of a specified request to the plan and a 
     determination by the plan with respect to such request for 
     each such item and service, excluding any such requests that 
     were not submitted with the medical or other documentation 
     required to be submitted by the plan.
       ``(IX) The percentage and number of specified requests that 
     were excluded from the calculation described in subclause 
     (VIII) based on the plan's determination that such requests 
     were not submitted with the medical or other documentation 
     required to be submitted by the plan.
       ``(X) Information on each occurrence during the previous 
     plan year in which, during a surgical or medical procedure 
     involving the furnishing of an applicable item or service 
     with respect to which such plan had approved a prior 
     authorization request, the provider of services or supplier 
     furnishing such item or service determined that a different 
     or additional item or service was medically necessary, 
     including a specification of whether such plan subsequently 
     approved the furnishing of such different or additional item 
     or service.
       ``(XI) A disclosure and description of any technology 
     described in subclause (VII) that the plan utilized during 
     the previous plan year in making determinations with respect 
     to specified requests.
       ``(XII) The number of grievances (as described in 
     subsection (f)) received by such plan during the previous 
     plan year that were related to a prior authorization 
     requirement.
       ``(XIII) Such other information as the Secretary determines 
     appropriate.

       ``(ii) The plan shall provide--

       ``(I) to each provider or supplier who seeks to enter into 
     a contract with such plan to furnish applicable items and 
     services under such plan, the list described in clause (i)(I) 
     and any policies or procedures used by the plan for making 
     determinations with respect to prior authorization requests;
       ``(II) to each such provider and supplier that enters into 
     such a contract, access to the criteria used by the plan for 
     making such determinations and an itemization of the medical 
     or other documentation required to be submitted by a provider 
     or supplier with respect to such a request; and
       ``(III) to an enrollee of the plan, upon request, access to 
     the criteria used by the plan for making determinations with 
     respect to prior authorization requests for an item or 
     service.

       ``(B) Option for plan to provide certain additional 
     information.--As part of the information described in 
     subparagraph (A)(i) provided to the Secretary during a plan 
     year, a Medicare Advantage plan may elect to include 
     information regarding the percentage and number of specified 
     requests made with respect to an individual and an item or 
     service that were denied by the plan during the preceding 
     plan year in an initial determination based on such requests 
     failing to demonstrate that such individuals met the clinical 
     criteria established by such plan to receive such items or 
     services.
       ``(C) Regulations.--The Secretary shall, through notice and 
     comment rulemaking, establish requirements for Medicare 
     Advantage plans regarding the provision of--
       ``(i) access to criteria described in subparagraph 
     (A)(ii)(II) to providers of services and suppliers in 
     accordance with such subparagraph; and
       ``(ii) access to such criteria to enrollees in accordance 
     with subparagraph (A)(ii)(III).
       ``(D) Publication of information.--The Secretary shall 
     publish information described in subparagraph (A)(i) and 
     subparagraph (B) on a public website of the Centers for 
     Medicare & Medicaid Services. Such information shall be so 
     published on an individual plan level and may in addition be 
     aggregated in such manner as determined appropriate by the 
     Secretary.
       ``(E) Medpac report.--Not later than 3 years after the date 
     information is first submitted under subparagraph (A)(i), the 
     Medicare Payment Advisory Commission shall submit to Congress 
     a report on such information that includes a descriptive 
     analysis of the use of prior authorization. As appropriate, 
     the Commission should report on statistics including the 
     frequency of appeals

[[Page H7798]]

     and overturned decisions. The Commission shall provide 
     recommendations, as appropriate, on any improvement that 
     should be made to the electronic prior authorization programs 
     of Medicare Advantage plans.
       ``(F) Specified request defined.--For purposes of this 
     paragraph, the term `specified request' means a prior 
     authorization request made with respect to an applicable item 
     or service.
       ``(4) Enrollee protection standards.--For purposes of 
     paragraph (1)(A)(ii), the Secretary shall, through notice and 
     comment rulemaking, specify the following enrollee protection 
     standards with respect to the use of prior authorization by 
     Medicare Advantage plans for applicable items and services:
       ``(A) Adoption of transparent prior authorization programs 
     developed in consultation with enrollees and with providers 
     and suppliers with contracts in effect with such plans for 
     furnishing such items and services under such plans;
       ``(B) Allowing for the waiver or modification of prior 
     authorization requirements based on the performance of such 
     providers and suppliers in demonstrating compliance with such 
     requirements, such as adherence to evidence-based medical 
     guidelines and other quality criteria; and
       ``(C) Conducting annual reviews of such items and services 
     for which prior authorization requirements are imposed under 
     such plans through a process that takes into account input 
     from enrollees and from providers and suppliers with such 
     contracts in effect and is based on consideration of prior 
     authorization data from previous plan years and analyses of 
     current coverage criteria.
       ``(5) Applicable item or service.--For purposes of this 
     subsection, the term `applicable item or service' means, with 
     respect to a Medicare Advantage plan, any item or service for 
     which benefits are available under such plan, other than a 
     covered part D drug.
       ``(6) Reports to congress.--
       ``(A) GAO.--Not later than the end of the fourth plan year 
     beginning on or after the date of the enactment of this 
     subsection, the Comptroller General of the United States 
     shall submit to Congress a report containing an evaluation of 
     the implementation of the requirements of this subsection and 
     an analysis of issues in implementing such requirements faced 
     by Medicare Advantage plans.
       ``(B) HHS.--Not later than the end of the fifth plan year 
     beginning after the date of the enactment of this subsection, 
     and biennially thereafter through the date that is 10 years 
     after such date of enactment, the Secretary shall submit to 
     Congress a report containing a description of the information 
     submitted under paragraph (3)(A)(i) during--
       ``(i) in the case of the first such report, the fourth plan 
     year beginning after the date of the enactment of this 
     subsection; and
       ``(ii) in the case of a subsequent report, the 2 plan years 
     preceding the year of the submission of such report.''.
       (b) Ensuring Timely Responses for All Prior Authorization 
     Requests Submitted Under Part C.--Section 1852(g) of the 
     Social Security Act (42 U.S.C. 1395w-22(g)) is amended--
       (1) in paragraph (1)(A), by inserting ``and in accordance 
     with paragraph (6)'' after ``paragraph (3)'';
       (2) in paragraph (3)(B)(iii), by inserting ``(or, subject 
     to subsection (o), with respect to prior authorization 
     requests submitted on or after the first day of the third 
     plan year beginning after the date of the enactment of the 
     Improving Seniors' Timely Access to Care Act of 2022, not 
     later than 24 hours)'' after ``72 hours''.
       (3) by adding at the end the following new paragraph:
       ``(6) Timeframe for response to prior authorization 
     requests.--Subject to paragraph (3) and subsection (o), in 
     the case of an organization determination made with respect 
     to a prior authorization request for an item or service to be 
     furnished to an individual submitted on or after the first 
     day of the third plan year beginning after the date of the 
     enactment of this paragraph, the organization shall notify 
     the enrollee (and the physician involved, as appropriate) of 
     such determination no later than 7 days (or such shorter 
     timeframe as the Secretary may specify through notice and 
     comment rulemaking, taking into account enrollee and 
     stakeholder feedback) after receipt of such request.''.

     SEC. 3. FUNDING.

       The Secretary of Health and Human Services shall provide 
     for the transfer, from the Federal Hospital Insurance Trust 
     Fund established under section 1817 of the Social Security 
     Act (42 U.S.C. 1395i) and the Federal Supplementary Medical 
     Insurance Trust Fund established under section 1841 of such 
     Act (42 U.S.C. 1395t) (in such proportion as determined 
     appropriate by the Secretary) to the Centers for Medicare & 
     Medicaid Services Program Management Account, of $25,000,000 
     for fiscal year 2022, to remain available until expended, for 
     purposes of carrying out the amendments made by this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Washington (Ms. DelBene) and the gentleman from Pennsylvania (Mr. 
Kelly) each will control 20 minutes.
  The Chair recognizes the gentlewoman from Washington.


                             General Leave

  Ms. DelBENE. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Washington?
  There was no objection.
  Ms. DelBENE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, more than 28 million seniors get healthcare through 
Medicare Advantage, including 600,000 in Washington State.
  For these seniors and the physicians that care for them, we must 
deliver a quality product that allows providers to keep our seniors as 
healthy as possible while reducing wait times, paperwork, and hassle.
  Unfortunately, the cumbersome and antiquated prior authorization 
process that many Medicare Advantage plans utilize often gets in the 
way. This involves multiple phone calls and faxing documents to 
insurance companies. It is 2022, and even Congress has moved beyond 
faxing.
  The HHS Inspector General recently reported that prior authorization 
is responsible for delaying and even denying medically necessary care. 
That mirrors reports that we have heard from providers for years now.
  In one case, the inspector general found that, due to prior 
authorization, a 76-year-old Medicare beneficiary with post-polio 
syndrome was denied a request for a walker.
  In another case, a Washington State resident and professional 
fisherman had to miss this past summer's fishing season in Alaska 
because his hip surgery was delayed for months.
  According to the American Medical Association, one out of every four 
physicians report that prior authorization has led to a patient being 
hospitalized. Prior authorization is also a burden on providers, who 
spend 13 hours a week completing prior authorization paperwork, often 
for procedures that are approved over 95 percent of the time. That is 
time they could be spending with patients.
  Today, the House of Representatives will take a major step forward in 
resolving this problem. The Improving Seniors' Timely Access to Care 
Act will make commonsense changes to prior authorization to ensure our 
seniors are getting the care they need when they need it.
  First, the bill would require all plans to use an electronic prior 
authorization system. That means no more phone calls, no more faxes, 
and no more wondering what information is needed to submit to insurance 
plans when requesting prior authorization.
  Second, we establish a process for real-time decisionmaking. It 
doesn't make sense that services in line with standard clinical 
practice guidelines or services that are approved more than 95 percent 
of the time are subject to prior authorization.
  We also know that delayed approvals can result in patients falling 
through the cracks and missing out on care. Real-time decisions will 
help stop that.
  Finally, this bill requires reporting on the number of prior 
authorization requests, the rates of approvals and denials, and the 
rates of successful appeals to increase transparency.
  Collectively, this bill will help providers spend more time with 
patients and less time with paperwork.
  Today's vote and the teamwork that brought this legislation to this 
moment is a bipartisan success story that shows that Congress can come 
together and put the needs of the American people before the gridlock 
that we all know too well.
  Mr. Speaker, I thank Representative   Mike Kelly, our Republican 
lead, for his tireless work on this for years, also our co-leads, Dr. 
Ami Bera and Larry Bucshon, as well as Senator Roger Marshall, who 
worked with us when he was in the House in the 116th Congress and has 
continued this effort in the Senate.
  I thank the over 300 of my colleagues on both sides of the aisle who 
have cosponsored this bill. The support for this legislation has been 
overwhelming and it has been endorsed by over 500 healthcare 
organizations.
  I particularly thank the Regulatory Relief Coalition and the American 
Medical Association that helped develop a quality bill and build 
support for it.
  Mr. Speaker, I include in the Record a list of endorsements and the 
letters

[[Page H7799]]

of support from the Regulatory Relief Coalition and the American 
Medical Association.

The Improving Seniors' Timely Access to Care Act of 2021 (S. 3018/H.R. 
                                 3173)

         List of 500 Supporting Organizations (as of 7/6/2022)


                          National Supporters

       2020 Mom, ACCSES, Academy of Consultation-Liaison 
     Psychiatry, Accuray, Inc., AdvaMed, Aimed Alliance, ALK 
     Positive, Inc., Alliance for Aging Research, Alliance for 
     Headache Disorders Advocacy, Alliance for Patient Access, 
     Alliance of Specialty Medicine, ALS Association, Alzheimer's 
     Association and Alzheimer's Impact movement, America's 
     Physician Groups, American Academy of Allergy, Asthma & 
     Immunology, American Academy of Child and Adolescent 
     Psychiatry, American Academy of Dermatology Association, 
     American Academy of Emergency Medicine, American Academy of 
     Family Physicians, American Academy of Hospice and Palliative 
     Medicine, American Academy of Neurology, American Academy of 
     Ophthalmology, American Academy of Otolaryngic Allergy, 
     American Academy of Otolaryngology--Head and Neck Surgery, 
     American Academy of PAs.
       American Academy of Physical Medicine and Rehabilitation, 
     American Academy of Sleep Medicine, American Association for 
     Hand Surgery, American Association for Homecare, American 
     Association for Marriage and Family Therapy, American 
     Association for Pediatric Ophthalmology and Strabismus, 
     American Association for Physician Leadership, American 
     Association for Psychoanalysis in Clinical Social Work, 
     American Association of Clinical Endocrinology, American 
     Association of Clinical Urologists, American Association of 
     Neurological Surgeons, American Association of Neuromuscular 
     & Electrodiagnostic Medicine, American Association of Nurse 
     Anesthetists, American Association of Orthopaedic Surgeons, 
     American Association on Health and Disability, American 
     Clinical Laboratory Association, American Clinical 
     Neurophysiology Society, American College of Allergy, Asthma 
     and Immunology, American College of Cardiology, American 
     College of Emergency Physicians, American College of 
     Gastroenterology, American College of Medical Genetics and 
     Genomics, American College of Mohs Surgery, American College 
     of Obstetricians and Gynecologists.
       American College of Osteopathic Internists, American 
     College of Osteopathic Surgeons, American College of 
     Physicians, American College of Radiation Oncology, American 
     College of Radiology, American College of Rheumatology, 
     American College of Surgeons, American Counseling 
     Association, American Epilepsy Society, American Foundation 
     for Suicide Prevention, American Gastroenterological 
     Association, American Geriatrics Society, American Glaucoma 
     Society, American Group Psychotherapy Association, American 
     Health Information Management Association, American Hospital 
     Association, American Institute of Ultrasound in Medicine, 
     American Medical Association, American Medical Rehabilitation 
     Providers Association, American Medical Women's Association, 
     American Mental Health Counselors Association, American 
     Nurses Association, American Occupational Therapy 
     Association, American Optometric Association, American 
     Osteopathic Association, American Osteopathic College of 
     Ophthalmology, American Physical Therapy Association, 
     American Psychiatric Association, American Psychiatric Nurses 
     Association, American Psychoanalytic Association, American 
     Psychological Association, American Society for Clinical 
     Pathology, American Society for Gastrointestinal Endoscopy.
       American Society for Laser Medicine and Surgery, American 
     Society for Radiation Oncology, American Society of 
     Anesthesiologists, American Society of Breast Surgeons, 
     American Society of Cataract and Refractive Surgery, American 
     Society of Dermatopathology, American Society of 
     Echocadiography, American Society of Hematology, American 
     Society of Neuroradiology, American Society of Nuclear 
     Cardiology, The American Society of Pain and Neuroscience, 
     American Society of Plastic Surgeons, American Society of 
     Retina Specialists, American Society of Transplant Surgeons, 
     American Society of Transplant Surgeons (ASTS), American 
     Society of Echocardiography, American Therapeutic Recreation 
     Association, American Urogynecologic Society, American 
     Urological Association, American Vein & Lymphatic Society, 
     American Venous Forum, America's Essential Hospitals, Anxiety 
     and Depression Association of America, Arthritis Foundation, 
     Association for Ambulatory Behavioral Healthcare, Association 
     for Clinical Oncology, Association of Academic Physiatrists, 
     Association of Black Cardiologists, Association of Community 
     Cancer Centers, Association of Freestanding Radiation 
     Oncology Centers, Association of Mature American Citizens, 
     Association of Rehabilitation Nurses, Association of 
     University Professors of Ophthalmology.
       Association of Women in Rheumatology, Better Medicare 
     Alliance, Beyond Type 1, Boston Scientific, Brain Injury 
     Association of America, Bridge the Gap--SYNGAP Education and 
     Research Foundation, Cancer Support Community, CancerCare, 
     Case Management Society of America, CHAMP--Coalition for 
     Headache and Migraine Patients, Change Healthcare, Child 
     Neurology Society, Children and Adults with Attention-
     Deficit/Hyperactivity Disorder, Chris CJ Johnson Foundation 
     Inc., Christopher & Dana Reeve Foundation, Chronic Care 
     Policy Alliance, Clinical Social Work Association, Coalition 
     of Long-Term Acute-Care Hospitals, Cohere Health, College of 
     Psychiatric and Neurologic Pharmacists, Community Liver 
     Alliance, Community Oncology Alliance, Congress of Clinical 
     Rheumatology, Congress of Neurological Surgeons, Consortium 
     of Multiple Sclerosis Centers, Continuum Therapy Partners, 
     Cooley's Anemia Foundation, Cornea Society, Corporation for 
     Supportive Housing (CSH), Depression and Bipolar Support 
     Alliance, Diabetes Leadership Council, Diabetes Patient 
     Advocacy Coalition.
       Driven To Cure, Eating Disorders Coalition for Research, 
     Policy & Action, Endocrine Society, Epic Systems, Epilepsy 
     Foundation, Eye Bank Association of America, Falling Forward 
     Foundation, Federation of American Hospitals, Ferrell 
     Foundation, Free2Care, Global Alliance for Behavioral Health 
     and Social Justice, Global Healthy Living Foundation, Global 
     Liver Institute, GO2 Foundation for Lung Cancer, The Headache 
     and Migraine Policy Forum, Healthcare Information and 
     Management Systems Society, HealthPRO-Heritage, Hematology/
     Oncology Pharmacy Association, Hyperemesis Education and 
     Research Foundation, International Essential Tremor 
     Foundation, International Foundation for Autoimmune & 
     Autoinflammatory Arthritis, International OCD Foundation, 
     Johnson & Johnson, Judy Nicholson Kidney Cancer Foundation, 
     KCCure (Kidney Cancer Research Alliance), The Kennedy Forum, 
     Kidney Cancer Association, KidneyCAN, Lakeshore Foundation, 
     LeadingAge, The Leukemia & Lymphoma Society, Lupus and Allied 
     Diseases Association, Inc.
       Maternal Mental Health Leadership Alliance, Medical Device 
     Manufacturers Association, Medical Group Management 
     Association, Medical Oncology Association of Southern 
     California, Mental Health America, The Michael J. Fox 
     Foundation for Parkinson's Research, Multiple Sclerosis 
     Association of America, NAADAC, the Association for Addiction 
     Professionals, National Alliance of Safety-Net Hospitals, 
     National Alliance on Mental Illness, National Association for 
     Behavioral Healthcare, National Association for Children's 
     Behavioral Health, National Association for Home Care & 
     Hospice, National Association for the Advancement of 
     Orthotics and Prosthetics, National Association for the 
     Support of Long Term Care, National Association of ACOs, 
     National Association of Epilepsy Centers, National 
     Association of Rehab Providers & Agencies, National 
     Association of Social Workers, National Association of Spine 
     Specialists, National Association of State Head Injury 
     Administrators, National Association of State Mental Health 
     Program Directors, National Community Pharmacists 
     Association, National Comprehensive Cancer Network, National 
     Council for Mental Wellbeing, National Disability Rights 
     Network, National Eating Disorders Association, National 
     Federation of Families, National Hispanic Medical 
     Association.
       National Kidney Foundation, National League for Nursing, 
     National Multiple Sclerosis Society, National Osteoporosis 
     Foundation, National Patient Advocate Foundation, National 
     Register of Health Service Psychologists, NHMH--No Health 
     without Mental Health, Nomi Health, North American Neuro-
     Ophthalmology Society, OCHIN, Outpatient Ophthalmic Surgery 
     Society, Pacific Spine & Pain Society, Partnership for 
     Quality Home Healthcare, Patients Rising, Patients Rising 
     Now, Physician Hospitals of America, Physicians Advocacy 
     Institute, Postpartum Support International, Premier, Private 
     Practice Section (PPS) of the American Physical Therapy 
     Association (APTA), Prostate Network, Pulmonary Fibrosis 
     Foundation, R.M.C. Inc., REDC Consortium, Regulatory Relief 
     Coalition, Rehabilitation Engineering and Assistive 
     Technology Society of North America (RESNA), Remote Cardiac 
     Services Providers Group, Renal Physicians Association, 
     RetireSafe, SMART Recovery, Society for Cardiovascular 
     Angiography and Interventions, Society for Cardiovascular 
     Magnetic Resonance, Society for Vascular Surgery.
       Society of Cardiovascular Computed Tomography, Society of 
     Gynecologic Oncology, Society of Hospital Medicine, Society 
     of Interventional Radiology, The Society of Thoracic 
     Surgeons, Spina Bifida Association, Spine Intervention 
     Society, Susan G. Komen, Sterling Vision, Tourette 
     Association of America, Treatment Communities of America, 
     Triage Cancer, VHL Alliance, ZERO--The End of Prostate 
     Cancer.


                            state supporters

       Medical Association of the State of Alabama, Alabama 
     Academy of Ophthalmology, Alabama Association of Health 
     Information Management, Alabama Cancer Congress, Alabama 
     Chapter, American College of Surgeons, Alabama Society for 
     the Rheumatic Diseases, Alaska Chapter, American College of 
     Surgeons, The Arizona Clinical Oncology Society, Arizona 
     Chapter, American College of Surgeons, Arizona Health 
     Information Management Association, Arizona Neurosurgical 
     Society, Arkansas Chapter, American College of Surgeons, 
     Arkansas Medical Society, Arkansas Ophthalmological Society, 
     Arkansas Orthopaedic Society, Arkansas Rheumatology 
     Association, Association of Northern California Oncologists, 
     Brooklyn-Long Island Chapter, American College of Surgeons, 
     California Medical Association, California Academy of Eye 
     Physicians and Surgeons, California Association of

[[Page H7800]]

     Neurological Surgeons, Medical Oncology Association of 
     Southern California, Inc., Centura Health.
       Colorado Chapter, American College of Surgeons, Colorado 
     Medical Society, Colorado Society of Eye Physicians & 
     Surgeons, Community Care Network of Kansas, Connecticut 
     Chapter, American College of Surgeons, Connecticut Oncology 
     Association, Connecticut State Medical Society, Medical 
     Society of Delaware, Delaware Chapter, American College of 
     Surgeons, Delaware Society for Clinical Oncology, Medical 
     Society of the District of Columbia, Denali Oncology Group, 
     DHR Health, Eastern Long Island Chapter, American College of 
     Surgeons, Empire State Hematology and Oncology Society, 
     Florida Medical Association, Florida Academy of Family 
     Physicians, Florida Chapter, American College of Surgeons, 
     Florida Health Information Management Association, Florida 
     Neurosurgical Society, Florida Society of Clinical Oncology, 
     The Florida Society of Neurology, Florida Society of 
     Ophthalmology, Medical Association of Georgia, Georgia 
     Neurological Society, Georgia Society of Clinical Oncology, 
     Georgia Society of Ophthalmology.
       Georgia Society of the American College of Surgeons, Guam 
     Chapter, American College of Surgeons, Hawaii Medical 
     Association, Hawaii Chapter, American College of Surgeons, 
     Hawaii Society of Clinical Oncology, Idaho Medical 
     Association, Idaho Chapter, American College of Surgeons, 
     Illinois State Medical Society, Illinois Academy of Family 
     Physicians, Illinois Chapter, American College of Surgeons, 
     Illinois Medical Oncology Society, Illinois State 
     Neurosurgical Society, Indiana State Medical Association, 
     Indiana Academy of Ophthalmology, Indiana Chapter, American 
     College of Surgeons, Indiana Neurological Society, Indiana 
     Oncology Society, Iowa Chapter, American College of Surgeons, 
     Iowa Medical Society, Iowa Oncology Society, Jacksonville 
     Chapter, American College of Surgeons, Kansas Chapter, 
     American College of Surgeons, Kansas Health Information 
     Management Association, Kansas Hospital Association, Kansas 
     Medical Society, Kansas Radiological Society, Kansas Society 
     of Clinical Oncology.
       Kentucky Medical Association, Kentucky Academy of Eye 
     Physicians & Surgeons, Kentucky Chapter, American College of 
     Surgeons, Kentucky Society of Clinical Oncology, Keystone 
     Chapter, American College of Surgeons, Lake Plains Medical 
     PLLC, Life Sciences Pennsylvania, Louisiana State Medical 
     Society, Louisiana Academy of Family Physicians, Louisiana 
     Chapter, American College of Surgeons, Louisiana Oncology 
     Society, Maine Medical Association, Maine Chapter, American 
     College of Surgeons, Maine Society of Eye Physicians and 
     Surgeons, Maryland Chapter, American College of Surgeons, 
     Maryland Society of Eye Physicians and Surgeons, Maryland/DC 
     Society of Clinical Oncology, Massachusetts Chapter, American 
     College of Surgeons, Massachusetts Health Information 
     Management Association (MaHIMA), Massachusetts Medical 
     Society, Massachusetts Society of Clinical Oncologists, 
     Massachusetts Society of Eye Physicians & Surgeons, MedChi, 
     The Maryland State Medical Society, Metropolitan Chicago 
     Chapter, American College of Surgeons, Metropolitan 
     Philadelphia Chapter, American College of Surgeons.
       Metropolitan Washington DC Chapter, American College of 
     Surgeons, Michigan Chapter, American College of Surgeons, 
     Michigan Society of Hematology and Oncology, Michigan State 
     Medical Society, Midwest Association for Medical Equipment 
     Services & Supplies, MidWest Rheumatology Association, 
     Minnesota Medical Association, Minnesota Academy of 
     Ophthalmology, Minnesota Health Information Management 
     Association, Minnesota Society of Clinical Oncology, 
     Minnesota Surgical Society--a Chapter of the ACS, American 
     College of Surgeons, Mississippi State Medical Association, 
     Mississippi Chapter, American College of Surgeons, 
     Mississippi Oncology Society, Missouri State Medical 
     Association, Missouri Academy of Family Physicians, Missouri 
     Chapter, American College of Surgeons, Missouri Oncology 
     Society, Montana Medical Association, Montana Academy of 
     Family Physicians, Montana and Wyoming Chapter, American 
     College of Surgeons, Montana State Oncology Society, MSARS, 
     Nebraska Medical Association, Nebraska Academy of Eye 
     Physicians and Surgeons, Nebraska Chapter, American College 
     of Surgeons, Nebraska Neurological Society.
       Nebraska Oncology Society, Neurosurgical Society of the 
     Virginias, Nevada State Medical Association, Nevada Chapter, 
     American College of Surgeons, Nevada Health Information 
     Management Association, Nevada Oncology Society, New 
     Hampshire Medical Society, New Hampshire Chapter, American 
     College of Surgeons, Medical Society of New Jersey, New 
     Jersey Academy of Ophthalmology, New Jersey Chapter, American 
     College of Surgeons, New Jersey Health Information Management 
     Association, Medical Oncology Society of New Jersey, New 
     Mexico Chapter, American College of Surgeons, New Mexico 
     Medical Society, New Mexico Society of Clinical Oncology, 
     Medical Society of the State of New York, New York Chapter, 
     American College of Surgeons, New York State Academy of 
     Family Physicians, New York State Neurosurgical Society, New 
     York State Ophthalmological Society, North Carolina Chapter, 
     American College of Surgeons, North Carolina Medical Society, 
     North Carolina Oncology Association, North Carolina Society 
     of Eye Physicians and Surgeons, North Dakota Medical 
     Association, North Dakota Chapter, American College of 
     Surgeons.
       North Texas Chapter, American College of Surgeons, Northern 
     California Chapter, American College of Surgeons, Northern 
     New England Clinical Oncology Society, Northwestern 
     Pennsylvania Chapter, American College of Surgeons, Ohio 
     State Medical Association, Ohio Academy of Family Physicians, 
     Ohio Association of Rheumatology, Ohio Chapter, American 
     College of Surgeons, Ohio Health Information Management 
     Association, Ohio Hematology Oncology Society Oklahoma State 
     Medical Association, Oklahoma Chapter, American College of 
     Surgeons, Oklahoma Society of Clinical Oncology Oregon 
     Medical Association, Oregon Academy of Family Physicians, 
     Oregon Academy of Ophthalmology, Oregon Chapter, American 
     College of Surgeons, Oregon Society of Medical Oncology, 
     Pennsylvania Medical Society, Pennsylvania Academy of 
     Ophthalmology, Pennsylvania Chapter of the American College 
     of Cardiology, Pennsylvania Medical Society, Pennsylvania 
     Neurosurgical Society, Pennsylvania Rheumatology Society, 
     Pennsylvania Society of Oncology & Hematology, The Hospital 
     and Healthsystem Association of Pennsylvania, PHIMA.
       Prodigy Rehabilitation Group, Inc., PT Northwest, Puerto 
     Rico Chapter, American College of Surgeons, Puerto Rico 
     Hematology and Medical Oncology Association, Rhode Island 
     Chapter, American College of Surgeons, Rhode Island Health 
     Information Management Association, Rhode Island Medical 
     Society, Rhode Island Neurological Society, Rocky Mountain 
     Oncology Society, San Diego Chapter, American College of 
     Surgeons, Society of Utah Medical Oncologists, South Carolina 
     Chapter, American College of Surgeons, South Carolina 
     Oncology Society, South Dakota Academy of Ophthalmology, 
     South Dakota Chapter, American College of Surgeons, South 
     Florida Chapter, American College of Surgeons, South Texas 
     Chapter, American College of Surgeons, Southern California 
     Chapter, American College of Surgeons, Southwest Missouri 
     Chapter, American College of Surgeons, Southwestern 
     Pennsylvania Chapter, American College of Surgeons, Tennessee 
     Medical Association, Tennessee Chapter, American College of 
     Surgeons, Tennessee Oncology Practice Society, Texas Medical 
     Association, Texas Academy of Family Physicians.
       Texas Hospital Association, Texas Ophthalmological 
     Association, Texas Society of Clinical Oncology, Transitional 
     Care Management, Utah Medical Association, Utah Chapter, 
     American College of Surgeons, Utah Ophthalmology Society, 
     Vermont Chapter, American College of Surgeons, Vermont 
     Medical Society, Medical Society of Virginia, Virginia 
     Association of Hematologist & Oncologist, Virginia Chapter, 
     American College of Surgeons, Virginia Society of Eye 
     Physicians and Surgeons, Washington D.C. Metropolitan 
     Ophthalmological Society, Washington State Medical 
     Association, Washington Academy of Eye Physicians & Surgeons, 
     Washington Academy of Family Physicians, Washington Chapter, 
     American College of Surgeons, Washington State Association of 
     Neurological Surgeons.
       Washington Rheumatology Alliance, Washington State Medical 
     Oncology Society, West Virginia Chapter, American College of 
     Surgeons, West Virginia Oncology Society, West Virginia 
     Orthopaedic Society, Western New York Chapter, American 
     College of Surgeons, Wisconsin Medical Society, Wisconsin 
     Academy of Ophthalmology, Wisconsin Association of Hematology 
     & Oncology, Wisconsin Health Information Management 
     Association, Wisconsin Hospital Association, Wisconsin 
     Neurological Society, Wisconsin Rheumatology Association, 
     Wisconsin Surgical Society--a Chapter of the ACS, The Woman's 
     Group, Wyoming Medical Society, Wyoming State Oncology 
     Society.
                                  ____


                                  Regulatory Relief Coalition,

                                               September 12, 2022.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Republican Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: Members of the 
     Regulatory Relief Coalition (RRC)--a group of national 
     physician specialty organizations advocating for reduced 
     regulatory burdens that interfere with patient care--thank 
     you for scheduling a House floor vote on the Improving 
     Seniors' Timely Access to Care Act on September 14, 2022.
       This bipartisan bill is supported by more than 310 House 
     co-sponsors and over 500 endorsing organizations representing 
     patients, health care providers, medical technology and 
     biopharmaceutical industry, health plans and others. The 
     RRC's goal is to ensure that bureaucratic hurdles do not 
     stand in the way of physicians providing medically necessary 
     patient care.
       The Improving Seniors' Timely Access to Care Act would 
     improve prior authorization in the Medicare Advantage (MA) 
     program by:
       Establishing an electronic prior authorization (ePA) 
     program;
       Standardizing and streamlining the prior authorization 
     process for routinely approved services, including 
     establishing a list of services eligible for real-time prior 
     authorization decisions;
       Ensuring prior authorization requests are reviewed by 
     qualified medical personnel; and

[[Page H7801]]

       Increasing transparency on MA prior authorization 
     requirements and their use.
       The RRC, which served as a lead stakeholder and key 
     negotiator of the legislation, especially appreciates the 
     tireless work of Reps. Suzan DelBene (D-WA), Mike Kelly (R-
     PA), Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) for 
     their efforts leading up to this vote.
       We urge the House to vote in favor of this critical 
     legislation.
       If you have any questions, please contact Peggy Tighe.
       Thank you.
           Sincerely,
       The Regulatory Relief Coalition, American Academy of Family 
     Physicians, American Academy of Neurology, American Academy 
     of Ophthalmology, American Academy of Orthopaedic Surgeons, 
     American Association of Neurological Surgeons, American 
     College of Cardiology, American College of Rheumatology, 
     American College of Surgeons, American Gastroenterological 
     Association, American Osteopathic Association, Association 
     For Clinical Oncology, Congress of Neurological Surgeons, 
     Medical Group Management Association, National Association of 
     Spine Specialists, Society for Cardiovascular Angiography & 
     Interventions.
                                  ____


                                 American Medical Association,

                                               September 13, 2022.
      Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Ranking Member McCarthy: On behalf 
     of the physician and medical student members of the American 
     Medical Association (AMA), I write in strong support of H.R. 
     3173, the ``Improving Seniors' Timely Access to Care Act of 
     2022.'' This legislation, as originally introduced, garnered 
     more than 300 bipartisan House cosponsors and the support of 
     approximately 500 physician, hospital, patient, and insurer 
     organizations. We greatly appreciate the House of 
     Representatives scheduling a vote on this bipartisan 
     legislation, which was favorably reported out of the Ways and 
     Means Committee in July, and strongly urge swift passage to 
     help streamline, simplify, and standardize prior 
     authorization processes within Medicare Advantage (MA) plans.
       Prior authorization, which is the practice by insurance 
     companies of reviewing and potentially denying medical 
     services and pharmaceuticals prior to treatment, remains a 
     principal frustration for patients and physicians. This 
     utilization management policy is overused, costly, opaque, 
     burdensome to physicians, and harmful to patients due to 
     delays in care.
       AMA data compiled from annual surveys of more than l,000 
     practicing physicians continue to illustrate the negative 
     impact of prior authorization policies. In fact, 34 percent 
     of physicians who participated in a 2021 AMA survey reported 
     that prior authorization led to a serious adverse event, such 
     as hospitalization, disability, permanent bodily damage, or 
     even death, for a patient in their care. The 2021 survey also 
     highlights that 93 percent of physicians reported care delays 
     associated with prior authorization, while 82 percent of 
     respondents cited that these requirements can at least 
     sometimes lead to patients abandoning treatments.
       In addition, research from the federal government 
     demonstrates that prior authorization leads to delays in 
     patient care and inappropriate denials of medically necessary 
     services. A 2018 report from the Department of Health and 
     Human Services (HHS) Office of Inspector General (OIG) 
     concluded that, between 2014 and 2016, MA plans overturned 75 
     percent oftheir own prior authorization and payment denials 
     when appealed by providers and beneficiaries. An April 2022 
     HHS OIG report also found that 13 percent of prior 
     authorization requests denied by MA plans met Medicare 
     coverage rules, and 18 percent of payment request denials met 
     Medicare and MA billing rules.
       We commend the House of Representatives for working in a 
     bipartisan fashion to develop an amended version of the 
     Improving Seniors' Timely Access to Care Act. The modified 
     legislation retains the crux of the original bill, the 
     ``Improving Seniors' Timely Access to Care Act of 2021,'' 
     including mandating that MA plans implement electronic prior 
     authorization programs that adhere to new standards adopted 
     by the federal government. This will help ensure that 
     physicians are no longer forced to resort to faxes and e-
     forms, or even disparate, proprietary portals that fail to 
     comply with these newly developed standards, when seeking to 
     complete prior authorization requests. In addition, the 
     provisions requiring robust data reporting, such as the 
     number and percentage of prior authorization requests 
     approved, denied, or approved upon appeal, will bring much 
     needed transparency to ensure MA prior authorization programs 
     are not inappropriately denying medically necessary care to 
     patients and overburdening physicians with unnecessary 
     requirements.
       Most importantly, the additional sections of the 
     legislation mandating MA plans to issue faster prior 
     authorization decisions are crucial policy improvements that 
     will ensure more timely access to care and, as a result, 
     improve patient health care outcomes and better stewardship 
     of scarce Medicare resources. The AMA supports the 
     requirements for health plans to provide real-time prior 
     authorization decisions for routinely approved services, as 
     defined in implementing regulations. We also appreciate that 
     the bill directs MA plans unable to meet the real-time 
     processing requirement in the event of ``extenuating 
     circumstances'' to issue final prior authorization decisions 
     within a 72-hour and 24-hour timeline for regular and 
     emergent services, respectively. Notably, the legislation 
     requires MA plans to report the number of prior 
     authorizations subject to this exception, providing the 
     transparency needed to deter abuse of this provision.
       In addition, we sincerely appreciate the inclusion of 
     provisions pertaining to more timely prior authorization 
     decisions for all other services within Medicare Part C. 
     Requiring MA plans to issue final decisions within 24 hours 
     for emergent services and no later than seven days after 
     receipt of regular prior authorization requests is a vast 
     improvement over current MA program practices. The expedited 
     timelines for MA plans to issue final prior authorization 
     decisions, both for routinely approved care and all other 
     services, will undoubtedly lessen the burden on physicians, 
     and, most significantly, ensure timely patient care and 
     improved health outcomes.
       The AMA is proud to support the Improving Seniors' Timely 
     Access to Care Act. We commend the House of Representatives 
     for voting on this legislation and stand ready to work to 
     ensure bipartisan passage by the Senate.
           Sincerely,
                                              James L. Madara, MD.

  Ms. DelBENE. Mr. Speaker, I also thank the staff from the personal 
offices and from the committee and leadership offices that have spent 
countless hours researching this issue and working with stakeholders to 
develop this legislation.
  In particular, I thank my former legislative director, Kyle Hill, who 
was truly integral in developing and advancing this legislation.
  Mr. Speaker, I urge all of my colleagues to support this legislation, 
and I reserve the balance of my time.
  Mr. KELLY of Pennsylvania. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I thank Representative DelBene for being with me today.
  We are really proud of this bill because it has taken a lot of time 
to get there, and it has taken so many people on both sides of the 
aisle looking at it and saying this is something that just makes sense.
  The purpose of the Improving Seniors' Timely Access to Care Act is 
very simple: it is to protect our seniors. They deserve fast, high-
quality care when they see their doctor, not bureaucratic paperwork and 
delays. Unfortunately, our current prior authorization system often 
produces just that.
  My office has heard countless stories of Pennsylvanians being 
affected by having their care delayed due to prior authorizations. One 
ophthalmology practice reported that they had problems getting both of 
a patients' eyes authorized for a basic operation because the system 
rejected the second eye as a duplicate.
  At the University of Pittsburgh's Department of Neurosurgery, doctors 
can perform an advanced surgery with a Gamma Knife to control brain 
tumors. In many cases, these operations give patients life and more 
time. The problem is that it takes prior authorization, and care is 
delayed for way, way too long costing patients' valuable time.
  As a result, patients lose confidence in the medical system, and they 
also begin to lose hope. That is why we are here today, to move the 
prior authorization process into the 21st century and give doctors and 
health insurance plans the tools they need to make these decisions more 
quickly.
  The current system allows insurance plans to take weeks to review 
prior authorization requests, leaving patients waiting. The process is 
often manual, requiring fax machines, phone calls, and paper 
submissions, meaning doctors cannot easily appeal these decisions.
  The Improving Seniors' Timely Access to Care Act requires prior 
authorization decisions to be done faster, helping seniors get care 
more quickly. Most routinely approved prior authorization items and 
services will receive a real-time electronic response.
  For nonroutinely approved items, doctors and patients will have clear 
expectations of how long they are going to need to wait for a response, 
allowing them to better coordinate their care.
  Additionally, health insurance plans must begin to disclose data on 
how many prior authorizations they approve or deny, along with an 
analysis of how they made that decision.

[[Page H7802]]

  Truthfully, I have seen many similar situations in the business I 
have been in my whole life. I am an automobile dealer, and when we are 
working on an owner's car under warranty, too often it is a negotiation 
with a manufacturer on what repairs we are able to do.
  The manufacturer does their own time studies on how long they think 
it should take and what they think should be repaired. But oftentimes 
those time studies are on a brand new car or truck just off the 
assembly line. As we all know, living in western Pennsylvania, we have 
a lot of steep hills, and we go through really rough winters where 
there are a lot of things put on the road--salt and whatever else--that 
can corrode different parts once they are in operation.
  It is the same story with insurance companies when we are doing 
covered auto body work. We have to give the insurance company the 
estimates before we ever touch a car or truck, and then continuously 
negotiate with them as we get into the tear-down of the vehicle and 
find other damage. We have to go back and get authorization to do that, 
and that holds up the process.
  As much as people say, now, wait, wait, wait, don't compare cars and 
trucks and that warranty work to patients. You know what? It is the 
same thing. It is the same thing. You are denied access to care that 
you need today, not tomorrow, not some time in the future. There is no 
reason why you should have to wait for it, not in today's world, and 
not with the way we are able to improve all of this.
  I know when I talked to Dr. Bera or Dr. Bucshon and especially with 
Ms. DelBene, we think: Why in the world are we working on old ways of 
getting answers as opposed to being able to get them today and get them 
more quickly?
  I just think what we are doing makes sense. I would rely more on a 
technician who has expert experience than somebody who does time 
studies on something that isn't actually the duplicate of what we are 
looking to do.

  This whole thing is about protecting our seniors, the people who have 
done the most for this generation and previous generations, who have 
really put their shoulders to the wheel and have never ever complained 
and always done what they think is best.
  Why in the world would we make it harder for them to get the 
healthcare they deserve? Why? That makes absolutely no sense to any of 
us. This is not a red concern or a blue concern. It is all about red, 
white, and blue. It is about Americans. It is not Republicans or 
Democrats or Libertarians or anything else. It is about this body's 
obligation to come together on issues that are really critical.
  There never should be this type of work that we have had to go 
through to get this done. And then all of a sudden last night, by the 
way, the CBO decided after 11 months to weigh in on how we would score 
this legislation. They waited until the 11th hour, and right after the 
11th hour they pulled back what they had said they thought the cost was 
going to be.
  I don't know how anybody runs a business like that.
  I know if I give somebody an estimate or tell somebody something is 
going to be done at a certain time--and I know we make commitments to 
all of the people we represent, give them the right answer in the right 
time. Why make them wait for something that is so basic?
  I know we always have this concern about fraud, waste, and abuse. My 
complaint really comes down to service. We can complain about a lot of 
things, but we cannot complain about what we owe our seniors.
  We wrote and rewrote this bill over the course of the last several 
years to ensure it was as strong as possible, using everything that is 
available to us today to implement, to get answers quicker, not longer, 
not put people off, not tell them to wait in the waiting room, not tell 
them to stay on hold, but to get them an answer and get them the care 
that they need today.

                              {time}  1230

  Feedback is important. Honesty is more important. I know Ms. DelBene 
and Dr. Bera and Dr. Bucshon and so many of our colleagues agree the 
same way, and all the staff members that you mentioned.
  This is not something that just happened very quickly and on the back 
of an envelope. This is something that a great deal of concern went 
into, a great deal of care went into, and a great deal of looking into 
went into.
  So I am going to thank my colleagues, and I am going to ask everybody 
today, when this comes up for a vote, please vote for seniors. Please 
vote for all of those who have done so much for all of us. And take 
this opportunity to thank them in a way that really makes sense and, 
that is, by saying, you have played the game well; you have played the 
game long. You have done so much for all of us. Why don't we do 
something for all of you?
  So I thank my colleague--it has been great--and all our colleagues 
for getting on board on this. It has been a really good example of how, 
when we actually work together on good policy and don't worry about the 
politics of it, amazing, amazing what can get done for the American 
people.
  Mr. Speaker, I reserve the balance of my time.
  Ms. DelBENE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Chu), my colleague on the Ways and Means Committee, 
another leader of this legislation.
  Ms. CHU. Mr. Speaker, I rise in strong support of my colleague, 
Representative DelBene's bill, the Improving Seniors' Timely Access to 
Care Act. I have heard from countless patients in my southern 
California district whose care has been delayed for weeks and, in some 
cases, outright denied because of countless barriers and archaic 
approval methods. And I have heard directly from physicians who are at 
their wits end, unable to provide the care they know will help their 
patients because of endless red tape.
  The Improving Seniors' Timely Access to Care Act makes thoughtful and 
much-needed improvements to the Medicare system to correct these 
problems. The bill before us today will promote modernization of the 
prior authorization system to speed up approvals of routine procedures.
  It moves the system of prior authorization into the 21st century, 
away from fax machines and toward electronic approval methods. By 
shortening the window by which insurance plans must respond to a prior 
authorization request, the bill will ensure patients get the care they 
need when they need it.
  I urge my colleagues to support this important legislation.
  Mr. KELLY of Pennsylvania. Mr. Speaker, I want to take a moment also 
to thank the Regulatory Relief Coalition because they have been working 
hand in hand with us trying to contact as many members as they can. And 
today is an example of when we work together, what we can get done.
  Mr. Speaker, I present one of the doctors in our Doctors Caucus from 
North Carolina, Dr. Murphy, to give his actually on-the-job, on-the-
field experience of what it is like to try to work through this massive 
group of--I don't know what you call these people. They are hard to 
work with and they don't represent us. They do represent something 
else. I think we need to represent just our folks back home.
  Mr. Speaker, I yield such time as he may consume to the gentleman 
from North Carolina (Mr. Murphy).
  Mr. MURPHY of North Carolina. Mr. Speaker, I thank Representatives 
DelBene and Kelly for putting forth the timely Improving Seniors' 
Timely Access to Care Act.
  Mr. Speaker, I would just like to explain to the public what pre-
authorization means. I am a practicing physician, so if I order a test, 
I recommend a surgery, it then goes into a bucket at an insurance 
agency, and then we play the great waiting game. The patient is no 
longer in the office because we have no idea how long that waiting game 
is. It was put in and accepted for what I believe was a good cause. But 
as with many government programs, or institutions, or institutions of 
our bureaucracy in the private sector even, it is something that has 
gone bad and gone terribly wrong.
  I may be waiting 2 or 3 or 4 weeks to speak with somebody who is not 
my peer. I am a surgeon. I may be speaking with a pediatrician or, even 
more, I might be speaking with a nurse practitioner who has no 
experience whatsoever in my field of study to get their approval of 
something that I know needs to happen. It is an absolutely antiquated 
system that does not work.

[[Page H7803]]

  I am going to give you a couple of examples. Approximately 10 weeks 
ago, I saw a prostate cancer patient. There were two avenues to go on 
this: Either he needed to be operated on very quickly, or the cat was 
out of the bag, and he needed intensive chemotherapy quickly.
  A week goes by, 2 weeks go by. What is that patient doing at home? He 
hasn't slept one wink because his entire future, his entire life, is 
then suspended in front of him.
  It took 3 weeks, 3 weeks to get the study that every urologist in the 
country knew was necessary to get that answer. Yet, in the meantime, 
that patient has lost years, just in life as far as worry.
  A second; one of my partners did a very complicated surgery on a 
patient. The patient was a bad diabetic; came in a week or two later 
with a wound infection. Fine, come in, get some intensive IV 
antibiotics. Try to get the patient out of the hospital because we know 
it is good to get patients out of the hospital when they don't need to 
be in the hospital.
  He needed a certain oral antibiotic that was prescribed for him. It 
was denied. It was denied. It was denied. A week and a half later, he 
shows up in my office as an emergency. I have to send him over somewhat 
late in the afternoon, so that means he gets on the OR schedule at 
10:00, 11:00, or 2 a.m., and has to have an abscess drained. And then 
he is in the hospital now another 2 weeks because he didn't get that 
antibiotic prescribed to him when he should have because it was denied, 
his authorization.

  Mr. Speaker, I know the CBO score came in. I don't believe it. I have 
lived and breathed this for 30-plus years. I don't believe it. It 
doesn't pass the smell test. To come up at the last minute with this 
score, in my opinion, is erroneous and needs to be looked at again, 
because I look at the savings that we, as physicians, provide in 
knowing what is right for our patients in the moment versus some 
bureaucrat in an insurance company who is given the directive to deny, 
deny, deny, is not what we should be doing in medicine. Our medical 
system has become bankrupt and these pre-authorizations are part of it.
  So I have a hard time going along with the CBO score of $16 billion 
because I don't believe it. This is what is right for patients. This is 
decades past the time when this should have been done.
  I look at the doctors that I have worked with, and we are just 
plagued in clinic, because we know what we are going to recommend for 
our patients after years of study and work with patients is going to be 
possibly denied by someone who has no experience who has been told by 
insurance companies, deny, deny, and deny until they wear out the 
doctor and wear out the patient.
  So, Mr. Speaker, this is a travesty, I believe, to not pass this 
bill. I also do not believe the CBO score, and I think it is a great 
injustice for our patients to be denied care because of this antiquated 
pre-authorization system.
  Ms. DelBENE. Mr. Speaker, it is so important that we work with 
experts in the medical community to develop strong legislation, and we 
are incredibly fortunate to have as one of our co-leads on this bill 
one of our doctors in Congress, so I want to thank him for all of his 
incredible work getting us to where we are today.
  I yield 3 minutes to the gentleman from California (Mr. Bera).
  Mr. BERA. Mr. Speaker, I want to first thank my colleague from the 
great State of Washington, Ms. DelBene, as well as my good friend from 
Pennsylvania, Mr. Kelly, as well as my fellow doctor, Dr. Bucshon.
  This was how legislative processes should work. You identify a 
challenge, you work on it, you work on it in a bipartisan way. But you 
put the American patient first because that is what this it about at 
the end of the day. How do we give efficient, quality care to America's 
patients, and, in this case, America's seniors.
  I have been practicing medicine going back to 1995. And yeah, I have 
used a fax machine back in 1995. This is about coming into the 21st 
century, modernizing the practice of medicine.
  It is also about letting us do what we went to medical school for, 
what we did residency for. After 4 years of undergrad, 4 years of 
medical school, anywhere from 3 to 7 years and longer of residency 
training, doctors want to be doctors. They want to take care of their 
patients.
  Yes, there is a role for prior authorization in limited cases. There 
is also a role to go back and retrospectively look at how care is being 
delivered. But what is happening today is a travesty. It wasn't the 
intention of prior authorization. It is a prior authorization process 
gone awry. And let me give you some examples.
  When I talk to my former colleagues, the folks I went to medical 
school with, they spend up to 40 percent of their time on paperwork, on 
administrative burden, on doing things that don't enhance clinical care 
or enhance their ability to take care of patients.
  We heard Dr. Murphy talk about the delays in care. That adds costs, 
that adds time, and in some cases, it occasionally will potentially 
kill a patient. That isn't what this is about.
  This is about providing America's seniors efficient care, reducing 
the burden, and allowing doctors to do what we went to medical school 
for, take care of patients.
  Let's bring this into the 21st century, and let's start to put the 
patient central in American healthcare. And that is how we are going to 
actually lower costs of care, deliver better outcomes, and improve 
satisfaction.
  We see a lot of doctors leaving the practice of medicine because of 
that administrative burden, the hassle factor. That doesn't improve 
care. That actually makes care worse.
  So let's move into the 21st century. Let's deliver that care, and 
let's move forward.
  This is a shining example of how Congress should work. If you think 
about it, 320-plus Members of Congress, in a bipartisan way, of the 
House, support this legislation. All of the doctors in Congress support 
this legislation. You have got Senate support of this legislation. Over 
500 groups of my colleagues support this legislation. It is about good 
medicine. It is about taking care of the patients.
  I also want to recognize my prior senior healthcare legislative 
assistant, Colleen Nguyen, who worked incredibly hard on this, as well 
as my current healthcare legislative assistant, Harsh Patel. As 
Congresswoman DelBene pointed out, it is the staff that makes us look 
good.
  Everybody should vote for this, and we should pass it unanimously.
  Mr. KELLY of Pennsylvania. Mr. Speaker, I yield myself the balance of 
my time.
  I know Dr. Bera is leaving the floor right now.
  So often, when I am home and I am here, we always pick winners and 
losers and, somehow, that becomes the main objective of who won, who 
lost. So we are worried today about the score. It doesn't matter on the 
score because everybody wins on this. There is no loser on this.
  And if we can't look to the people who have supported us our whole 
lives and have created opportunities that exist in this country on 
their backs, what in the world are we doing here?
  Well, I can't tell you how much I appreciate the opportunity to be 
with Ms. DelBene. This is incredible to get this done today.
  I am urging every single Member to vote for this. Please throw out 
your scorecard and look at the picture in your wallet of who it is that 
parented you or grandparented you and say you know what, wouldn't it be 
nice to give them something back after they gave us their whole life? 
And let them have some peace of mind.
  I don't think there is anything greater in your later years than 
peace of mind and being able to know that I am getting healthcare when 
I need it. I am not going to have to wait for somebody someplace else 
to determine whether I should get it.
  So it has been a pleasure working with you. It has been a pleasure 
working with all of our colleagues. And for Dr. Marshall, who used to 
sit here with us but now is over in the senior area of this magnificent 
model--although, I think he is too young to be there. Now, I am sure my 
older Senators will say, hey, Kelly, please don't call us old. I won't. 
Let's just say the more seasoned Members.
  But I am glad we can wrap this up on a really good note. I can't tell 
you how good I feel about this, that we can go

[[Page H7804]]

home and tell those people that we represent--I don't care how they 
vote. All I want them to know is we care about what they have done for 
us, and we are going to be able to supply them some peace of mind.
  Mr. Speaker, I yield back the balance of my time.

                              {time}  1245

  Ms. DelBENE. Mr. Speaker, I think it is past time for us to help our 
seniors get timely care. It is past time to help our medical 
professionals, our doctors, our nurses, and others who are burdened 
with undue paperwork, to help them spend more time providing care. It 
is past time for us to move a strong piece of legislation that has 
strong bipartisan support.
  I thank Chairman Neal and everyone who has helped bring this 
legislation forward, folks on the Ways and Means Committee, including 
my colleague Mr. Kelly.
  Mr. Speaker, I urge all of my colleagues to support this legislation, 
an incredible piece of work.
  Mr. Speaker, I yield back the balance of my time.

                                    Congress of the United States,


                                     House of Representatives,

                               Washington, DC, September 14, 2022.
       Mr. Blumenauer: Mr. Speaker, I am pleased to support this 
     important legislation to protect seniors' access to care in 
     the Medicare Advantage program.
       As many of you know, I have been a longtime champion of 
     Medicare Advantage, and it's enjoyed tremendous popularity in 
     Oregon. I believe that the way traditional fee-for-service 
     Medicare operates is not sustainable and that Medicare 
     Advantage is one of the tools we can use to demonstrate how 
     we can incentivize value.
       But this is only possible when the program operates as 
     intended. I have been deeply concerned about the reports of 
     delays in care, not only from the Inspector General, but from 
     the constituents that come into my office. For patients and 
     their families, being told that you need to wait longer for 
     care that your doctor tells you that you need is incredibly 
     frustrating and frightening. There's no comfort to be found 
     in the fact that your insurance company needs time to decide 
     if your doctor is right. For providers, the burden of prior 
     authorization is immense. And at a time where we consistently 
     hear that our health care workers are facing incredible 
     burnout and are leaving the profession in alarming rates, 
     it's critical that we remove unnecessary processes.
       There is no reason that patients should be waiting for 
     medically appropriate care especially when we know that this 
     can lead to worse outcomes. The fundamental promise of 
     Medicare Advantage is undermined when people are delaying 
     care, getting sicker, and ultimately costing Medicare more 
     money.
       The legislation we are taking up today is commonsense 
     policy that moves us towards the goals of the program and 
     protects our patients and providers from unnecessary 
     roadblocks to care. I want to commend Congresswoman DelBene 
     for her leadership on this issue and I look forward to 
     supporting this bipartisan legislation.

  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Washington (Ms. DelBene) that the House suspend the 
rules and pass the bill, H.R. 3173, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________