On June 12, a bipartisan group of congressional leaders reintroduced the Improving Seniors’ Timely Access to Care Act, which would streamline the prior authorization process under Medicare Advantage.
U.S. Sens. Roger Marshall, M.D. (R-Kan.), Kyrsten Sinema (I-Ariz.), John Thune (R-S.D.), and Sherrod Brown (D-Ohio) and U.S. Reps. Mike Kelly (R-Pa.), Suzan DelBene (D-Wash.), Larry Bucshon, M.D. (R-Ind.), and Ami Bera, M.D. (D-Calif.) reintroduced the bill, which passed the House unanimously during the last Congress and has received support from more than 380 national and state health care organizations, 42 senators, and 130 House members. Since the bill’s initial passage, the House and Senate have been collaborating with the Centers for Medicare & Medicaid Services (CMS) to address issues with the bill’s cost before it advances to the president’s desk for final passage.
This bill would establish an electronic prior authorization process for Medicare Advantage plans, increase transparency around Medicare Advantage prior authorization requirements and its use, clarify CMS authority to establish time frames for electronic prior authorization requests, expand beneficiary protections, and require the U.S. Department of Health and Human Services and other stakeholder agencies to report to Congress on ways to improve the program.
The reintroduction of the bill comes months after CMS released its final rule reforming prior authorization programs for medical services. Effective April 8, 2024, the rule optimizes the electronic exchange of health information and prior authorization processes for various medical items and services. Impacted payers under the rule include Medicare Advantage organizations, Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans offered on the Federally Facilitated Exchanges.
Sources:
https://www.cap.org/advocacy/latest-news-and-practice-data/june-18-2024#story2
