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September 9, 2019Dear Members of Congress:The undersigned patient, physician, health care professional, and other health care stakeholderorganizations strongly support the Improving Seniors’ Timely Access to Care Act of 2019 (H.R.3107) recently introduced by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), RogerMarshall, MD (R-KS), and Ami Bera, MD (D-CA). This bipartisan legislation would helpprotect patients from unnecessary delays in care by streamlining and standardizing priorauthorization under the Medicare Advantage program, providing much-needed oversight andtransparency of health insurance for America’s seniors. We urge you to join your colleagues insupporting this important legislation.Based on a consensus statement on prior authorization reform adopted by leading nationalorganizations representing physicians, medical groups, hospitals, pharmacists, and health plans,the legislation would facilitate electronic prior authorization, improve transparency forbeneficiaries and providers alike, and increase Centers for Medicare & Medicaid Services (CMS)oversight on how Medicare Advantage plans use prior authorization. Specifically, the billwould: Create an electronic prior authorization program including the electronic transmission ofprior authorization requests and responses and a real-time process for items and servicesthat are routinely approved;Improve transparency by requiring plans to report to CMS on the extent of their use ofprior authorization and the rate of approvals or denials;Require plans to adopt transparent prior authorization programs that are reviewedannually, adhere to evidence-based medical guidelines, and include continuity of care forindividuals transitioning between coverage policies to minimize any disruption in care;Hold plans accountable for making timely prior authorization determinations and toprovide rationales for denials; andProhibit additional prior authorization for medically-necessary services performed duringa surgical or invasive procedure that already received, or did not initially require, priorauthorization.The demand and need for such reforms is growing — particularly as more seniors chooseMedicare Advantage for their health insurance needs. According to a recently released KaiserFamily Foundation report, “A Dozen Facts About Medicare Advantage in 2019,” MedicareAdvantage enrollment has nearly doubled in a decade. One-third (34%) of all Medicarebeneficiaries — 22 million people — are enrolled in Medicare Advantage plans, and nearly fourout of five enrollees (79%) are in plans that require prior authorization for some services. TheCongressional Budget Office (CBO) projects that beneficiaries enrolled in Medicare Advantageplans will rise to nearly half of all Medicare beneficiaries (about 47%) by 2029. Recognizing theneed to protect a growing number of Medicare beneficiaries, more than 100 members ofCongress called for such reforms in a letter last year to the CMS.

Improving Seniors’ Timely Access to Care Act of 2019September 9, 2019Page 2 of 10For our seniors — and as representatives of organizations seeking to protect patients from delaysin care and relieve unnecessary administrative burdens that impede delivery of timely care—weare committed to advancing this legislation in Congress and ask that you join RepresentativesDelBene, Kelly, Marshall, and Bera in co-sponsoring H.R. 3107 and securing its enactment.Thank you.Sincerely,ACCSESAimed AllianceAlliance for Aging ResearchAlliance for Balanced Pain ManagementAlliance for Patient AccessAlliance of Specialty MedicineAlzheimer's AssociationAlzheimer's Impact MovementAMDA – The Society for Post-Acute and Long-Term Care MedicineAmerican Academy of Allergy, Asthma & ImmunologyAmerican Academy of Dermatology AssociationAmerican Academy of Facial Plastic and Reconstructive SurgeryAmerican Academy of Family PhysiciansAmerican Academy of Hospice and Palliative MedicineAmerican Academy of NeurologyAmerican Academy of OphthalmologyAmerican Academy of Otolaryngology – Head and Neck SurgeryAmerican Academy of PAsAmerican Academy of Physical Medicine & RehabilitationAmerican Academy of Sleep MedicineAmerican Alliance of Orthopaedic ExecutivesAmerican Association of Clinical EndocrinologistsAmerican Association of Clinical UrologistsAmerican Association of Hip and Knee SurgeonsAmerican Association of Neurological SurgeonsAmerican Association of Nurse PractitionersAmerican Association of Orthopaedic SurgeonsAmerican Association of Pediatric Ophthalmology and StrabismusAmerican Association on Health and DisabilityAmerican Autoimmune Related Diseases AssociationAmerican Brain CoalitionAmerican Cancer Society Cancer Action NetworkAmerican Clinical Laboratory AssociationAmerican Clinical Neurophysiology SocietyAmerican College of Allergy, Asthma and ImmunologyAmerican College of Cardiology

Improving Seniors’ Timely Access to Care Act of 2019September 9, 2019Page 2 of 10American College of Emergency PhysiciansAmerican College of GastroenterologyAmerican College of Mohs SurgeryAmerican College of Obstetricians and GynecologistsAmerican College of Osteopathic SurgeonsAmerican College of PhysiciansAmerican College of Radiation OncologyAmerican College of RadiologyAmerican College of RheumatologyAmerican College of SurgeonsAmerican Congress of Rehabilitation MedicineAmerican Dance Therapy AssociationAmerican Gastroenterological AssociationAmerican Geriatrics SocietyAmerican Glaucoma SocietyAmerican Group Psychotherapy AssociationAmerican Liver FoundationAmerican Medical AssociationAmerican Medical Rehabilitation Providers AssociationAmerican Medical Women’s AssociationAmerican Music Therapy AssociationAmerican Nurses AssociationAmerican Occupational Therapy AssociationAmerican Osteopathic AssociationAmerican Osteopathic Colleges of Ophthalmology and OtolaryngologyAmerican Physical Therapy AssociationAmerican Psychiatric AssociationAmerican Psychoanalytic AssociationAmerican Society for Clinical PathologyAmerican Society for Gastrointestinal EndoscopyAmerican Society for Radiation OncologyAmerican Society for Radiology and OncologyAmerican Society for Surgery of the HandAmerican Society of AnesthesiologistsAmerican Society of Cataract & Refractive SurgeryAmerican Society of Clinical OncologyAmerican Society of EchocardiographyAmerican Society of HematologyAmerican Society of Interventional Pain PhysiciansAmerican Society of NephrologyAmerican Society of NeuroimagingAmerican Society of NeuroradiologyAmerican Society of Nuclear CardiologyAmerican Society of Ophthalmic Plastic and Reconstructive SurgeryAmerican Society of Plastic Surgeons

Improving Seniors’ Timely Access to Care Act of 2019September 9, 2019Page 2 of 10American Society of Retina SpecialistsAmerican Society of Transplant SurgeonsAmerican Spinal Injury AssociationAmerican Urological AssociationAmerican Uveitis SocietyAmerican Vein & Lymphatic SocietyAmerican-European Congress of Ophthalmic SurgeryAmerica's Physician GroupsArthritis FoundationAssociation for Molecular PathologyAssociation of Academic PhysiatristsAssociation of American Medical CollegesAssociation of Black CardiologistsAssociation of Rehabilitation NursesAssociation of University Professors of OphthalmologyBeyond Type 1Brain Injury Association of AmericaBridge the Gap - SYNGAP Education and Research FoundationCancer Support CommunityCancerCareCaregiver Action NetworkChild Neurology FoundationChildren with DiabetesChristopher & Dana Reeve FoundationClinician Task ForceCMSC- Consortium of Multiple Sclerosis CentersCoalition For Headache And Migraine PatientsCollege Diabetes NetworkCollege of American PathologistsCommunity Oncology AllianceCongress of Neurological SurgeonsCornea SocietyCrohn's & Colitis FoundationDelaware Academy of OphthalmologyDepression and Bipolar Support AllianceDerma Care Access NetworkDiabetes Patient Advocacy CoalitionDiabetesSistersDigestive Disease National CoalitionDisability Rights Education and Defense FundDystonia Advocacy NetworkDystonia Medical Research FoundationEpilepsy FoundationEye and Contact Lens AssociationEye Bank Association of America

Improving Seniors’ Timely Access to Care Act of 2019September 9, 2019Page 2 of 10Federation of American HospitalsFree2CareGBS CIDP Foundation InternationalGlobal Alliance for Behavioral Health and Social JusticeGlobal Healthy Living FoundationGlobal Liver InstituteHealthcare Information and Management Systems SocietyHematology/Oncology Pharmacy AssociationIFAA - International Foundation for Autoimmune & Autoinflammatory ArthritisInternational Essential Tremor FoundationInternational Foundation for Gastrointestinal DisordersInternational Society for the Advancement of Spine SurgeryInterstitial Cystitis AssociationLupus and Allied Diseases Association, Inc.Medical Group Management AssociationMETAvivorMovement Disorders Policy CoalitionMultiple Sclerosis Association of AmericaNational Alopecia Areata FoundationNational Association for the Advancement of Orthotics & ProstheticsNational Association of Rural Health ClinicsNational Association of Social WorkersNational Association of Spine SpecialistsNational Association of State Head Injury AdministratorsNational Association of State Mental Health Program DirectorsNational Comprehensive Cancer NetworkNational Diabetes Volunteer Leadership CouncilNational Health CouncilNational Infusion Center AssociationNational Lipid AssociationNational Medical Association, Ophthalmology SectionNational Multiple Sclerosis SocietyNational Osteoporosis FoundationNational Pancreas FoundationNational Patient Advocate FoundationNephCure Kidney InternationalNorth American Neuro-Ophthalmology SocietyOcular Microbiology and Immunology GroupOutpatient Endovascular and Interventional SocietyPartnership to Advance Cardiovascular HealthPartnership to Fight Chronic DiseasePartnership to Improve Patient CarePrevent BlindnessPulmonary Hypertension AssociationRemote Cardiac Services Provider Group

Improving Seniors’ Timely Access to Care Act of 2019September 9, 2019Page 2 of 10Renal Physicians AssociationRestless Legs Syndrome FoundationRetireSafeSjogren's Syndrome FoundationSociety for Cardiovascular Angiography and InterventionsSociety for Vascular SurgerySociety of Critical Care MedicineSociety of Gynecologic OncologySociety of Hospital MedicineSpine Intervention SocietyThe Headache and Migraine Policy ForumThe Leukemia & Lymphoma SocietyThe Marfan FoundationThe Michael J. Fox Foundation for Parkinson's ResearchThe Retina SocietyThe Society of Thoracic SurgeonsTourette Association of AmericaTreatment Communities of AmericaUniform Data System for Medical RehabilitationUnited Spinal AssociationUS Hereditary Angioedema AssociationAlabama Academy of OphthalmologyAlabama Society for the Rheumatic DiseasesLakeshore FoundationMedical Association of the State of AlabamaNeurosurgical Society of AlabamaAlaska Rheumatology AllianceAlaska Society of Eye Physicians and SurgeonsDenali Oncology Group Alaska Chapter ASCOArizona Medical AssociationArizona Neurosurgical SocietyArizona United Rheumatology AllianceThe Arizona Clinical Oncology SocietyArkansas Medical SocietyArkansas Ophthalmological SocietyArkansas Rheumatology AssociationAssociation of Northern California OncologistsCalifornia Academy of Eye Physicians and SurgeonsCalifornia Association of Neurological SurgeonsCalifornia Medical AssociationCalifornia Rheumatology AllianceMedical Oncology Association of Southern California, Inc.Cedars/Aspens, non-profit society of ophthalmic surgeon educatorsColorado Medical Society