MA Prior Auth Bill Gets $10B Informal Score; Proponents Reassess Next Steps

February 27, 2023

The Congressional Budget Office issued an informal score of $10 billion for a highly watched bipartisan bill to streamline Medicare Advantage prior authorization, experts told Inside Health Policy -- an estimate that is at least $2 billion higher than stakeholders had hoped. The sponsors and proponents of the Improving Seniors’ Timely Access To Care Act are reassessing their next steps, including eyeing a second informal rescore or tweaks to the bill.

The bill to transition Medicare Advantage prior authorizations to an electronic system accrued overwhelming bipartisan support in both the House and Senate last congressional session, but ultimately fell short due to its cost. The Congressional Budget Office slapped a $16 billion price tag on the legislation shortly after it passed the House, and lawmakers’ year-end deal came together before CBO had time to rescore the bill.

House Speaker Kevin McCarthy’s (R-CA) staff asked CBO to rescore the bill in mid-January, and strongly encouraged CBO to use a cost analysis included in CMS’ proposed rule on prior authorization, according to a brief from the Regulatory Relief Coalition. Sen. Roger Marshall’s (R-KS) office told Inside Health Policy that Marshall had likewise pointed CBO toward CMS’ cost analysis as part of his ongoing efforts to demonstrate that prior authorization reforms would improve efficiency.

Marshall’s office said it’s unclear how CBO factored in its cost analysis three proposed rules on MA prior authorization, as well as other information the bill sponsors shared. Their next step is to meet with CBO to understand the revised baseline and to what degree the resources they provided had been taken into account, if at all. That information will help the bipartisan, bicameral bill sponsors work collaboratively with House and Senate Committees of jurisdiction and leadership to adjust the legislation and bring the score down to a negligible amount.

Marshall’s office previously told Inside Health Policy the lawmaker worked to demonstrate to CBO that increased efficiencies through electronic prior authorization will not ultimately lead to doctors providing more services -- and thus an increase in costs for Medicare.

One expert said the legislation isn’t expected to move quickly without a significantly lower score, and added that the bill’s proponents are working to bring down the score as close to zero as possible. Even the bill’s high degree of bipartisan popularity likely won’t be enough for it to move given ongoing discussions about spending and debt, the expert added.

There are still several options lawmakers could use to ease the bill’s passage, the expert said, including determining whether there are further opportunities for CBO to do additional cost assessment based on CMS’ impact analysis. The bill’s sponsors could also opt to tweak the bill, but the expert said there’s yet to be any discussion of next steps.

At press time, Rep. Suzan DelBene (D-WA) -- one of the bill’s sponsors -- could not be reached for comment.

Courtney Yohe Savage, senior vice president of policy and advocacy for the Cancer Support Community, called on Congress to pass prior authorization reform as soon as possible, adding that patients’ lives are at risk as long as prior authorizations drive delays in care.

“While I hope this new score reflects CBO’s continued misunderstanding of the rules governing MA plans and their reluctance to change that perspective until the rules are finalized, I’m afraid this just confirms what we already knew: MA plans use prior authorization to deny patients appropriate and desperately needed care,” Savage said. “We are counting on Congress to move forward with this essential legislation and build efficiency and transparency into the prior authorization process. This is the only way that we can combat the stark reality of CBO’s assumptions and ensure more patients receive the treatment they need.” -- Bridget Early (