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Health care industry

Improving Seniors' Timely Access to Care Act

Strategic Insights

— 1 min read

U.S. Senator John Cornyn (R-TX) has joined a bipartisan group of 45 senators to introduce the Improving Seniors' Timely Access to Care Act, aimed at streamlining the prior authorization process for seniors enrolled in Medicare Advantage plans. This legislation seeks to reduce unnecessary delays and burdens on healthcare providers, allowing them to focus on patient care rather than administrative tasks. The bill builds upon the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.

Key Takeaways:

  • The Improving Seniors' Timely Access to Care Act focuses on streamlining the prior authorization process to improve access to care for seniors enrolled in Medicare Advantage plans.
  • The bill would establish an electronic prior authorization process, increase transparency around Medicare Advantage prior authorization requirements, and clarify the authority of the Department of Health and Human Services (HHS) to establish timeframes for e-prior authorization requests.
  • The legislation aims to expand beneficiary protections, improve enrollee experiences, and outcomes, and requires HHS and other agencies to report to Congress on program integrity efforts and ways to further improve the e-prior authorization process.
  • The bill would result in a zero cost to American taxpayers.
  • 45 senators, including Sens. Roger Marshall, M.D. (R-KS), Mark Warner (D-VA), and John Cornyn (R-TX), have cosponsored the legislation.
  • Prior authorization continues to be the number-one administrative burden identified by healthcare providers, with nearly three out of four Medicare Advantage enrollees experiencing unnecessary delays due to the practice.
  • In 2018, an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.

Statistics:

  • 75% of requests were ultimately denied by Medicare Advantage plans despite being approved later (audit, 2018).
  • Nearly three out of four Medicare Advantage enrollees (73%) experience unnecessary delays due to prior authorization (source: Office of Inspector General, 2022).
  • The bill was supported by a supermajority of members in the Senate (60) and a majority in the House (232) last Congress.
  • The Improving Seniors' Timely Access to Care Act would result in a zero cost to American taxpayers.

Sources:

  • United States Senator for Texas John Cornyn
  • Centers for Medicare & Medicaid Services (CMS)
  • Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule, finalized by CMS on January 17, 2024
  • Office of the Inspector General at the U.S. Department of Health and Human Services (HHS)
  • Report by the HHS Office of Inspector General, 2022

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