NASHVILLE, Tenn. – U.S. Senators Marsha Blackburn (R-Tenn.), Roger Marshall, M.D. (R-Kan.), and a group of bipartisan colleagues reintroduced the Improving Seniors’ Timely Access to Care Act, which would streamline the prior authorization process under Medicare Advantage (MA), allowing seniors to get the care they need and helping health care providers put patients over paperwork:
“Modernizing and streamlining the prior authorization process is essential for reducing the administrative burden on doctors and ensuring timely access to care for our seniors. This bill is critical for Tennesseans, as it will help alleviate unnecessary delays in receiving medical treatments, improve patient outcomes, and allow healthcare providers to focus more on patient care rather than paperwork,” said Senator Blackburn.
“Prior authorization is the number one administrative burden facing physicians today across all specialties,” said Senator Marshall. “As a physician, I understand the frustration this arbitrary process is causing health care practices across the country and the headaches it creates for our nurses. With the bipartisan, bicameral, Improving Seniors’ Timely Access to Care Act, we will streamline prior authorization and help improve patient outcomes and access to quality care and life-saving medicine. With the improvements we’ve made there is no reason we should not quickly get this bill signed into law.”
The Improving Seniors’ Timely Access to Care Act unanimously passed the House last Congress and was cosponsored by a majority of members in the Senate and House of Representatives.
BACKGROUND
- Prior authorization (PA) is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services, but it’s not without fault. The current system often results in unconfirmed faxes of a patient’s medical information or phone calls by clinicians, which takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers, and three out of four Medicare Advantage enrollees are subject to unnecessary delays due to prior authorization.
- In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. More recently, HHS OIG released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.
- Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.
THE IMPROVING SENIORS’ TIMELY ACCESS TO CARE ACT WOULD
- Establish an electronic prior authorization process for MA plans, including a standardization for transactions and clinical attachments.
- Increase transparency around MA prior authorization requirements and its use.
- Clarify Centers for Medicare & Medicaid Services’ (CMS) authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests.
- Expand beneficiary protections to improve enrollee experiences and outcomes.
- Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.
ENDORSEMENTS
This bill is supported by over 370 national and state organizations representing patients, physicians, MA plans, hospitals, and other key stakeholders in the health care industry. To see the full list, click here.
CO-SPONSORS
Senate original co-sponsors include Kyrsten Sinema (I-Ariz.), John Thune (R-S.D.), Sherrod Brown (D-Ohio), Sheldon Whitehouse (D-R.I.), Bill Cassidy, M.D. (R-La.), Maggie Hassan (D-N.H.), Thom Tillis (R-N.C.), Tom Carper (D-Del.), John Cornyn (R-Texas), Bob Casey (D-Pa.), John Boozman (R-Ark.), Debbie Stabenow (D-Mich.), Jerry Moran (R-Kan.), Amy Klobuchar (D-Minn.), J.D. Vance(R-Ohio), Kirsten Gillibrand (D-N.Y.), Ted Budd (R-N.C.), Tim Kaine(D-Va.), Josh Hawley (R-Mo.), Jeanne Shaheen (D-N.H.), Cindy Hyde-Smith (R-Miss.), Mark Kelly (D-Ariz.), Kevin Cramer (R-N.D.),Jacky Rosen (D-Nev.), Mike Braun (R-Ind.), Martin Heinrich (D-N.M.), Eric Schmitt (R-Mo.), John Hickenlooper (D-Colo.), Marco Rubio (R-Fla.), Gary Peters (D-Mich.), Mike Rounds (R-S.D.), Peter Welch (D-Vt.), John Hoeven (R-N.D.), Alex Padilla (D-Calif.), Susan Collins (R-Maine), Richard Blumenthal (D-Conn.), Deb Fischer (R-Neb.), Raphael Warnock (D-Ga.), Brian Schatz (D-Hawaii), Jeff Merkley (D-Ore.), John Fetterman (D-Pa.), Elizabeth Warren (D-Mass.), and Catherine Cortez Masto (D-Nev.).
The full text of the bill is here.
