Bipartisan Bill Aims to Streamline Prior Authorization Process for Medicare Advantage Beneficiaries

Strategic Insights -

Senators John Boozman (R-AR), Roger Marshall, M.D. (R-KS), and Mark Warner (D-VA) have introduced the Improving Seniors' Timely Access to Care Act, a bipartisan bill aimed at speeding up access to care for Americans enrolled in Medicare Advantage (MA) plans. The legislation seeks to streamline the prior authorization process, which currently takes an average of 3-5 days, allowing healthcare providers to focus on patient care rather than administrative burdens.

Key Takeaways:

  • The Improving Seniors' Timely Access to Care Act would establish an electronic prior authorization process for Medicare Advantage plans, including standardization for transactions and clinical attachments.
  • The bill would clarify the Department of Health and Human Services' (HHS) authority to establish timeframes for e-prior authorization requests, including expedited determinations and real-time decisions.
  • The legislation would require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-prior authorization process.
  • The bill would expand beneficiary protections to improve enrollee experiences and outcomes.
  • Forty-four senators have cosponsored the bill, and companion legislation has been introduced in the U.S. House of Representatives.
  • The Improving Seniors' Timely Access to Care Act is supported by the Better Medicare Alliance, Humana, and 138 other health care organizations.
  • Mary Beth Donahue, President and CEO of Better Medicare Alliance, stated that the changes proposed in the legislation are "long overdue" and will help ensure seniors can get the care they need without delay.
  • Jim Rechtin, Humana CEO, said that the bill is a "common-sense approach" to making healthcare easier by modernizing the prior authorization process.

Statistics:

  • 32.8 million Americans, including over 300,000 Arkansans, are enrolled in a MA plan.
  • Prior authorization is the number one administrative burden facing physicians today across all specialties.
  • The bill aims to reduce the average 3-5 day wait time for prior authorization decisions.
  • The legislation would help healthcare providers focus on patient care, rather than administrative burdens.

Sources:

  • "Senators Introduce Bipartisan Improving Seniors' Timely Access to Care Act to Enhance Medicare Advantage Services" (United States Senate for Arkansas -- John Boozman website).
  • "Improving Seniors' Timely Access to Care Act" (United States Senate website).
  • "Better Medicare Alliance Applauds Senators' Efforts to Reform Medicare Prior Authorization Process" (Better Medicare Alliance website).
  • "Humana Statement on Seniors' Timely Access to Care Act" (Humana website).