■ The American Academy of Ophthalmology (AAO) released a statement commending the US House of Representatives for attaining the two-thirds majority of bipartisan support in Congress to allow H.R. 3173, Improving Seniors’ Timely Access to Care Act of 2021, on the Consensus Calendar.
The bill seeks to standardize prior authorization in the Medicare Advantage (MA) program, “providing much-needed oversight and transparency while protecting beneficiaries from unnecessary care delays and denials,” the AAO said. The legislation would require MA plans to:
- Establish an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities, including the ability to provide real-time decisions;
- Annually publish specified prior authorization information, including average response time and the percentage of requests approved, to improve transparency;
- Ensure prior authorization requests are reviewed by qualified medical personnel; and
- Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
“We’re pleased that Congress recognizes the importance of addressing egregious prior authorization policies and we hope lawmakers take swift action to pass this common-sense legislation,” said AAO’s CEO Stephen D. McLeod, MD.
In related news, Aetna announced that it will no longer require preapproval for cataract surgeries except for people enrolled in Medicare Advantage in Florida and Georgia. This comes after a year of sustained advocacy from the ophthalmology community, the AAO stated.
Last July, the insurer began requiring preapproval for all physician-prescribed cataract surgeries. The AAO has said it estimates that 10,000 to 20,000 Aetna beneficiaries had their cataract surgery unnecessarily delayed in that month alone. “The Academy has heard countless stories of patients who were delayed or denied sight-restoring care,” the group stated in a news release.
