00:03The Medicare Advantage Program provides millions of seniors with greater choices, added benefits, and coordinated care.
00:10Yet, it's also important to recognize that both its value in the areas where reform is needed.
00:15With that growth comes the responsibility to ensure the program is working as intended for both patients and for providers.
00:21That includes addressing delays caused by prior authorization and reducing the regulatory burden on those delivering care.
00:27I was glad to support Mr. Kelly's Improving Seniors Timely Access to Care Act of 2025, a common-sense bipartisan effort to modernize the prior authorization process.
00:37This bill cuts through red tape, streamlines approvals, and ensures that providers can stay focused on what truly matters, which is caring for their patients.
00:46Unfortunately, some providers have been forced to take to social media to share the real-world consequences of our broken system,
00:52including heartbreaking stories of patients who have been lying on the table waiting for authorization.
00:58And it's not just the patients and the providers, but it's also the families who are left bearing the emotional and logistical burden of these delays.
01:08And that's especially true at the end of life, which is why we should be cautious about the charges to end-of-life care,
01:14ensuring that we don't add more red tape or uncertainty for families already facing incredibly difficult moments.
01:20Mr. Chairman, I ask unanimous consent to enter into the record the following article by Hospice News titled,
01:26Timely Access to Hospice Care, a National Imperative.
01:29Without objection.
01:30Thank you, Mr. Chair.
01:31Ms. Moroney, when a patient suffers a major stroke or a traumatic brain injury, getting the right care at the right time is critical.
01:38And too often, patient care is delayed due to prior authorization processes and the patient sits for days in a hospital
01:44instead of following a doctor's recommendation to transfer to a specialized setting.
01:48In your opinion, is this the best way to care for patients in recovery?
01:53Absolutely not.
01:55In the sense of if they're being delayed, if a physician is, how should I say this,
02:01if the physician is directing care, then that patient should absolutely receive that care.
02:06I actually don't see that happen, specifically where there's a delay in care when somebody's sitting in a hospital, et cetera.
02:15It's usually on continuity of care or transition of care or post-care.
02:20So when they're being released to the hospital, we are very proactive on trying to make sure what's their plan.
02:27Do they live alone?
02:28Do they need to be in a skilled nursing facility?
02:31And is that skilled nursing facility at a high rate, like when it comes to star ratings or quality type measures?
02:36And then at that point when they're getting in the home, do they have food?
02:40Do they have other things that are accessible and available to them?
02:43That also starts in that process.
02:45And I know I've talked about the prior for us being less than 2%.
02:48We look at that continuity of care end to end all the way from the pre-service all the way to the post-service
02:55when it comes to actual care so that they are having mobility and independence when they're outside of a hospital setting.
03:03So are you aware of any timelines that Medicare Advantage plans must follow regarding how quickly they must approve prior authorization decisions?
03:11I do read about it, and I see it, and I hear it in the environment.
03:14We'll hear this from other organizations about the delay specifically.
03:19That just is not an experience with our company as a result of it.
03:23All right, Dr. Miller, I appreciate Imogene Bassett, right, in Cooperstown.
03:27My dad did his internship and his residency.
03:29We lived in Cooperstown.
03:30Unless you've suffered through some of their winters and gotten the benefit of their summers, it's a beautiful place.
03:37So I'm glad you mentioned that, brought back fond memories.
03:39I want to follow up on my previous question as a practicing hospitalist.
03:43When a patient's care is delayed due to prior authorization processes,
03:47is it fair to say that it's not just the patient who is impacted, but it's also another patient?
03:53Who may need hospital care and can't access it?
03:56Yeah, and it also impacts the doctor, too, right, because you're trying to make an excuse for why someone hasn't gone to a skilled nursing facility
04:03or an inpatient rehabilitation facility, and they're sitting there in the hospital, and you're saying,
04:09yeah, I'm sorry, I'm waiting for the plan.
04:11Now, the flip side of that is, ironically, sometimes that extra day or two in the hospital with physical therapy
04:18and occupational therapy might actually get that patient to a better place.
04:22So that patient who we needed to send to subacute rehab might actually be able to go home with home physical therapy.
04:29So I'd say it's good, but it's also bad.
04:32Okay.
04:33Dr. Basil, following up the question that I had asked to Ms. Moroney,
04:38have you seen any of those examples where people are waiting?
04:41So you brought up the stroke example.
04:43That's a great one where we've seen considerable pressure, you know, on stroke patient that has considerable rehab needs
04:49and really needs to go to an inpatient rehab level of stay that it is really difficult to get that approved in MA plans.
04:57And most of the time they get downgraded to skilled nursing level of care,
05:00which is a step down in intensity from inpatient rehab.
05:03And so I'd say that's a pretty consistent theme that we do see is that type of down code,
05:08down regulation of where we can send them versus where the physician thinks is best.
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