Legislation aiming to speed up and streamline the prior authorization process for Medicare Advantage (MA) beneficiaries was passed by the House on Sept. 14. The bipartisan bill, Improving Seniors’ Timely Access to Care Act (H.R. 3173), aims to put in place requirements and standards for MA prior authorization, the process insurance companies use to determine if a product or service will be covered, and if so, if it will be completely or partially covered.
According to the summary for the bill on Congress.gov, MA plans would need to meet three key requirements:
- Establish an electronic prior authorization program that meets specified standards, including the ability to provide real-time decisions in response to requests for items and services that are routinely approved
- Annually publish specified prior authorization information, including the percentage of requests approved and the average response time
- Meet other standards, as set by the Centers for Medicare & Medicaid Services, relating to the quality and timeliness of prior authorization determinations
The legislation would put a stop to “obstructive” prior authorization practices that delay or deny patients access to critical health services and treatments, healthcare groups say.
Healthcare Groups Overwhelmingly Support Bill
“Obstructive prior authorization practices create unnecessary delays for clinically appropriate, evidence-based treatments,” the American Society for Radiation Oncology (ASTRO) said in a recent press release. “These disruptions cause added anxiety for people who need life-saving cancer treatments, as delays in the start of radiation therapy are associated with worse outcomes for people with cancer. Prior authorization also wastes critical time and resources for clinics that are still rebounding from the ongoing pandemic.”
The American Hospital Association (AHA) also praised the recent House passage of the bill, which was first introduced in the House in May 2021 by Representatives Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera, MD (D-Calif.), and Larry Bucshon, MD (R-Ind.), gaining 323 co-sponsors out of 435 members of the House, according to the ASTRO press release.
“This legislation takes important steps to reduce the burden and complexity of prior authorization requirements imposed by Medicare Advantage plans,” the AHA said in a Sept. 14 statement. “These provisions will help Medicare patients access the care they need in a timely manner while reducing the strain on our already taxed health care workforce.”
Now that the bill is before the Senate, many of the almost 500 healthcare groups supporting it are urging the Senate to act quickly to advance the bill. However, early signs of support show promise that the bill will become law. According to both ASTRO and the American Academy of Ophthalmology, a complementary bill introduced in the Senate in October 2021 currently has 42 co-sponsors in the Senate, a level of support which the AHA says it “is encouraged by,” also urging the Senate “to take action on these critical protections” for patients.