U.S. Sen. Thom Tillis (R-NC) is one of 45 lawmakers supporting a newly introduced bipartisan bill that would streamline the prior authorization process under Medicare Advantage (MA) by bringing it into the electronic age.
“Arbitrary and unnecessary delays in care that stem from current prior authorization processes are unacceptable,” Sen. Tillis said on June 18. “This legislation will alleviate administrative burdens on physicians, cut red tape and, most importantly, ensure patients have uninterrupted access to quality care.”
Sen. Tillis on June 13 signed on as an original cosponsor of the Improving Seniors’ Timely Access to Care Act of 2024, S. 4532, which is sponsored by U.S. Sen. Roger Marshall (R-KS) and 43 other original cosponsors, including U.S. Sens. Marsha Blackburn (R-TN), Bill Cassidy (R-LA), Jerry Moran (R-KS), Mike Rounds (R-SD), John Hoeven (R-ND), Susan Collins (R-ME), Deb Fischer (R-NE), and Sherrod Brown (D-OH).
Specifically, S. 4532 would establish an electronic prior authorization (e-PA) process for MA plans, including a standardization for transactions and clinical attachments, and increase transparency around MA prior authorization requirements and its use, according to a summary provided by Sen. Tillis’ office.
Additionally, S. 4532 would clarify the authority of the Centers for Medicare & Medicaid Services to establish timeframes for e-PA requests, including expedited determinations and real-time decisions for routinely approved items and services, among other requests, the summary says.
The bill also would expand beneficiary protections to improve enrollee experiences and outcomes and require the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process, states the summary.
The measure has garnered support from almost 400 national and state organizations, such as AARP, the Susan G. Komen Foundation, the National Council for Mental Wellbeing, the National Association for Home Care & Hospice, the National Alliance on Mental Illness, the Alzheimer’s Association, and the American Hospital Association, among others.
S. 4532 is the companion bill to the same-named H.R. 8702, introduced on June 12 by U.S. Rep. Mike Kelly (R-PA) and 129 original cosponsors.