U.S. Reps Mike Kelly (R-PA) and John Joyce (R-PA) on May 20 proposed a bipartisan bill that would establish requirements regarding the use of prior authorization under Medicare Advantage plans.
“With nearly 33 million Americans enrolled in Medicare Advantage, modernization of the prior authorization process is long overdue,” Rep. Kelly said on May 22. “Lawmakers on both sides of the aisle, hundreds of healthcare organizations, and Americans from all corners of the country agree — streamlining this process will allow our nation’s seniors to receive the care they are entitled to more efficiently.”
Rep. Kelly sponsored the Improving Seniors’ Timely Access to Care Act, H.R. 3514, alongside 73 original cosponsors, including Rep. Joyce and U.S. Rep. Suzan DelBene (D-WA).
If enacted, H.R. 3514 would require Medicare Advantage (MA) plans that impose any prior authorization (PA) requirements to establish an electronic PA program that provides for the secure electronic transmission of both PA requests from healthcare providers and suppliers to the MA plan, as well as the corresponding response from the plan to the provider or supplier, according to a bill summary.
“When decisions on patient care are made by bureaucrats with no experience treating patients, care is often delayed or denied altogether, which results in worse outcomes for patients,” said Rep. Joyce. “By streamlining the prior authorization process through the bipartisan Improving Seniors’ Timely Access to Care Act, we can ensure that American patients receive the care they need without unnecessary barriers.”
Specifically, H.R. 3514 would establish an electronic PA process for MA plans, including a standardization for transactions and clinical attachments and increase transparency around PA requirements and its use, the summary says.
Additionally, the bill would clarify the authority of the U.S. Department of Health and Human Services (HHS) to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests; expand beneficiary protections to improve enrollee experiences and outcomes; and require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.
Rep. Kelly added that the proposed measure would move the healthcare sector into the 21st Century by giving doctors and MA plans the tools to make health coverage decisions in a timely manner.
U.S. Sens. Roger Marshall (R-KS) and Mark Warner (D-VA) introduced the companion bill in the Senate.