Advocacy news: Medicare Advantage changes; AI roadmap unveiled

Congress urged to simplify Medicare Advantage prior authorization

CAP members are calling for passage of the "Improving Seniors' Timely Access to Care Act" (S 1816, HR 3514) to streamline prior authorization processes in Medicare Advantage insurance plans.

It's a bipartisan bill: There’s broad consensus across political parties that enacting these prior authorization reforms into law would increase transparency, require real-time decisions for routine services, and expand patient protections. 

• The bill has 53 cosponsors in the Senate and 152 cosponsors in the House.
• It's backed by over 150 organizations, including the CAP. 

Action alert: Pathologists can easily contact their lawmakers and ask them to support the bill, too.

Contact Congress

Lawmakers open to making Medicare Advantage reforms

The rapid growth of Medicare Advantage (MA) has led Congress to consider options to lower costs while also hoping to improve program coverage.

Hearing highlights: On July 22, House Ways & Means Health and Oversight subcommittees asked expert witnesses for potential improvements.

• Patient enthusiasm for MA is why lawmakers should ensure its integrity, said Ways and Means Committee Chair Jason Smith (R-MO).
• It’s essential that Congress ensure prompt and fair payments, said committee Ranking Member Lloyd Doggett (D-TX).

The big picture: Half of Medicare beneficiaries now opt for MA plans, but physicians and hospitals say reforms are needed to improve reimbursements as they face greater financial pressures.

• The CAP has detailed several concerns about private health payers—including MA plans—and tactics that interfere with patient services.
• Read the CAP's recommendations to solve these problems.

Go deeper: Watch the hearing and read witness testimony.

CAP opposes HR 3164

The CAP, alongside the American Medical Association (AMA) and other medical societies, has co-signed a letter opposing the "Ensuring Community Access to Pharmacist Services (ECAPS) Act," (HR 3164), citing patient safety concerns.

The impact: The bill would allow pharmacists to perform services traditionally done by physicians, which could compromise patient care.

• The letter emphasizes the need for physician-led, team-based care to maintain health care quality.

The stakes: Allowing pharmacists to perform physician services may lead to misdiagnoses and uncoordinated care, negatively impacting patient outcomes and increasing health care costs.

Go deeper: The CAP and the AMA urge lawmakers to prioritize patient safety and reject the bill.

AI roadmap unveiled by White House

A national AI policy framework released by the Trump Administration will position the US as a technology leader by loosening regulations, the White House says. 

The impact: The Winning the Race plan calls on federal agencies to promote AI adoption across various sectors, including health care. The plan also supports safeguards that protect free speech and are ideologically unbiased.

Policies that would affect health care: 

• AI Adoption: Launch domain-specific efforts, led by the National Institute of Standards and Technology, to accelerate national standards for AI and measure productivity.
• Workforce: Expand AI literacy and skills development, evaluating AI’s labor market impact and piloting innovations.
• Discovery: Create world-class AI-ready scientific datasets while maintaining respect for individual rights. 

What's next: The CAP will monitor the plan’s progress and engage with federal agencies that take regulatory actions affecting pathologists and laboratories.