U.S. Reps. John Joyce (R-PA) and Greg Murphy (R-NC) on April 20 joined a bipartisan contingent in introducing legislation aimed at strengthening the Medicare Advantage program and ensuring America’s senior citizens receive timely, reliable access to care.
“Medicare is a promise to America’s seniors that they will have dependable access to quality healthcare in their later years,” Rep. Joyce said. “However, that promise has been undermined by unnecessary barriers to care — particularly through excessive use of prior authorization and inappropriate coverage denials in Medicare Advantage.”
The Medicare Advantage Improvement Act (MAIA), H.R. 8375, which Rep. Joyce sponsored alongside six original cosponsors, including Rep. Murphy and U.S. Rep. Kim Schrier (D-WA), would amend the Social Security Act to provide for certain reforms under the Medicare Advantage program.
“As a physician, I have seen firsthand how these delays harm patients and take valuable time away from the doctor-patient relationship,” said Rep. Joyce. “The Medicare Advantage Improvement Act will restore accountability, reduce unnecessary barriers, and ensure that seniors receive timely, high-quality care.”
If enacted, the bill would significantly reform prior authorization and coverage determination processes in Medicare Advantage plans, establish a new compliance scoring program, require 100 percent of claims for previously authorized services to be paid promptly (not just 95 percent), and would require plans to include adequate access to inpatient rehab facilities and long-term care hospitals as part of network adequacy compliance, among other provisions.
“Medicare Advantage should work for seniors, not enable health insurers to deny life-saving care,” said Rep. Murphy. “The Medicare Advantage Improvement Act is a common-sense step to rein in excessive prior authorization abuse, ensure timely access to care, and restore accountability in a system that too often delays or denies needed treatment.”
The measure is supported by Ascension, the American Medical Rehabilitation Providers Association, PAM Health, Community Health Systems, and Encompass Health.
“Health insurance companies have abused Medicare Advantage plans for too long, and they continue to skyrocket costs, deny coverage, and force taxpayers to pay the price. We need increased oversight into the Medicare Advantage program so that all seniors get the care they were promised,” said Rep. Schrier. “I am extremely proud to have worked on these much-needed Medicare Advantage reforms, which will hold insurance companies accountable and get patients timely, quality care.”