• APTA strongly supports legislation that would reduce administrative burden on physical therapists by modernizing the process for prior authorizations in Medicare.

    The Improving Seniors' Timely Access to Care Act of 2019 (H.R. 3107) was introduced in the US House of Representatives by representatives Susan Delbene (D-WA), Ami Bera (D-IL), Mike Kelly (R-PA), and Roger Marshall (R-KS). This legislation:

    1. Establishes an electronic prior authorization process,
    2. Requires the Secretary of HHS to establish a process for "real-time decisions" for items and services that are routinely approved,
    3. Prevents plans from requiring prior authorization on any additional invasive procedure if this procedure is furnished during the preoperative period of an already-approved procedure,
    4. Improves transparency by requiring Medicare Advantage plans to report to CMS on the use of prior authorization and the rate of approvals or denials, and requests that plans adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

    The increase in prior authorizations for medically necessary physical therapy services is increasing delay and impacting patients' clinical outcomes. The volume of prior authorizations and increase overall documentation has led to PTs experiencing administrative burden. This results in less time in the clinic and less patients receiving care. The need to modernize and improve transparency for prior authorizations is essential to improving care for Medicare Advantage patients.

    Position Paper

    Administrative Burden Infographic (.pdf)

    Current Cosponsors

    H.R. 3107 Improving Seniors’ Access to Care Act of 2019