Key Revisions Finalized for Federal IDR Processes Under No Surprises Act
The Departments of Health and Human Services, Labor, and Treasury and the Office of Personnel Management released a final rule May 28 to improve the...
1 min read
On May 20, Sens. Mark Warner (D-Va.) and Roger Marshall, M.D. (R-Kan.) reintroduced the Improving Seniors’ Timely Access to Care Act,which would establish requirements to streamline the prior authorization process under Medicare Advantage (MA) plans.
“Prior authorization is the number one administrative burden facing physicians today across all specialties … the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act … will streamline prior authorization and help improve patient outcomes and access to quality care,” Marshall said in a press release.
The bill was first introduced to Congress in 2022, when it was supported by a supermajority of Senate members and was unanimously passed by the House. It would codify and enhance provisions of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule, finalized by the Centers for Medicare & Medicaid Services on Jan. 17, 2024.
Provisions of the bill would establish an electronic prior authorization process for MA plans, including a standardization for transactions and clinical attachments. It would also expand beneficiary protections to improve enrollee experiences and outcomes.
Additionally, the bill would clarify the authority of the Department of Health and Human Services (HHS) to establish timeframes for electronic prior authorization requests, including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests. HHS and other agencies would also be required to report to Congress on program integrity efforts and other ways to further improve the electronic prior authorization process. Ultimately, the bill seeks to increase transparency around MA prior authorization requirements.
Source:
Stay Compliant with CMS and the New ABN Requirements
The Centers for Medicare & Medicaid Services (CMS) has issued an updated version of the Advance Beneficiary Notice of Noncoverage (ABN).
Prior Authorization Process Reform in Medicare Advantage Gaining Traction in Congress
The Improving Seniors’ Timely Access to Care Act (S.1816/H.R.3514) is gaining significant bipartisan support in both chambers of Congress.