Bipartisan Legislation Could Improve Medicare Advantage Prior Authorizations

In a rare unanimous vote, the House of Representatives has passed the “Improving Seniors’ Timely Access to Care Act.” As reported by Medical Economics, the proposed law will “make it easier for senior patients to get care and improve health outcomes by modernizing the ‘antiquated’ prior authorization process” for the 28 million seniors currently enrolled in a Medicare Advantage plan.

The text of the bill can be found here: https://www.congress.gov/bill/117th-congress/house-bill/3173

The bill summary outlines three new requirements for MA plans:

1. 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; 
2. annually publish specified prior authorization information, including the percentage of requests approved and the average response time; and 
3. meet other standards, as set by the Centers for Medicare & Medicaid Services, relating to the quality and timeliness of prior authorization determinations.

HealthLeaders points out that the legislation is widely supported, with the American Hospital Association saying the legislation “takes important steps to reduce the burden and complexity of prior authorization requirements imposed by Medicare Advantage plans” and the American Medical Association saying that “prior authorization is an insurance companies' practice that is overused, costly, opaque, burdensome to physicians, and harmful to patients due to delays in care.”

Perhaps that’s why this bill enjoys bipartisan support in both the House and the Senate. According to Modern Healthcare, the bill is expected to “advance after the November congressional elections.” So this bill isn’t law yet, but it could be by the end of the year.

AHCP recently published a blog post about sharing important news with your Medicare clients. You may want to take a look if you haven’t read it already as it will give you some ideas about different strategies for communicating this sort of information with your current and prospective clients.