House Passes Medicare Advantage Prior Authorization Bill

The U.S. House of Representatives recently passed by voice vote the Improving Seniors’ Timely Access to Care Act (H.R. 3173), legislation that would streamline prior authorization requirements under Medicare Advantage plans.

The bipartisan legislation would establish an electronic prior authorization process and reduce how long a health plan can consider a prior authorization request; create a “real-time decisions” process for routinely approved services; require plans to report on their prior authorization use and rate of approvals and denials; and encourage plans to adopt policies that adhere to evidence-based guidelines.

Provider organization advocacy groups applauded the bill’s passage. “Hospitals and health systems commend the U.S. House of Representatives for their passage of the Improving Seniors’ Timely Access to Care Act,” said American Hospital Association Executive Vice President Stacey Hughes, in a statement. “In particular, we thank Reps. DelBene, Kelly, Bera and Buschon and the leadership of the Ways and Means and Energy and Commerce Committees for their work on this important issue. This legislation takes important steps to reduce the burden and complexity of prior authorization requirements imposed by Medicare Advantage plans. These provisions will help Medicare patients access the care they need in a timely manner while reducing the strain on our already taxed healthcare workforce.”

Anders Gilberg, senior vice president, government affairs, for the Medical Group Management Association, said the transparency provisions included in this legislation — requiring MA plans to publicly reveal what services are subject to prior authorization, how many are approved, and how long on average they take to approve — will drive plan accountability. “Year after year, delays in coverage decisions, inconsistent payer payment policies, and unsustainable prior authorization volumes act as significant impediments to delivering medically necessary care,” Gilberg said in a statement. “At a time when group practices face unprecedented workforce shortage challenges, 89 percent of MGMA members report they do not have adequate staff to process the increasing number of prior authorizations from health insurers. This legislation would lessen administrative burden for medical groups by moving the prior authorization process into the 21st century.”

MGMA and AHA urged the Senate to move swiftly to take up the legislation.