Big Step For Bill to Streamline Prior Auth in Medicare AdvantageProgression in the passing of “The Improving Seniors’ Timely Access to Care Act of 2022” has been made. Lawmakers have come to an agreement on taking the next steps in the process. Passing this could allow Medicare users to get access to necessary tools quicker by ridding prior-authorization steps. Continue reading to learn more about the bill and where it stands right now.

The major legislative milestone for “The Improving Seniors’ Timely Access to Care Act of 2022”—which has broad bipartisan support—came via a bipartisan agreement between Ways and Means Committee Chair Richard Neal, a Massachusetts Democrat, and the committee’s ranking member, Texas Republican Kevin Brady.

Two other Ways and Means Committee members, Rep. Suzan DelBene, D-Wash., and Mike Kelly, R-Pa., are long-time supporters of prior-authorization reform and were instrumental in formulating the underlying legislation and pushing Neal and Brady to hold the hearing.

Why it’s important: “For years, the American Medical Association has sounded the alarm about burdensome prior-authorization processes and their negative impact on patient outcomes. Too often, prior authorization has resulted in delayed, denied or abandoned care,” said AMA President Jack Resneck Jr., MD.

AMA survey data (PDF) shows that “more than one-third (34%) of physicians reported that prior authorization led to a serious adverse event, such as hospitalization, disability or even death, for a patient in their care,” Dr. Resneck added.

The original House legislation, H.R. 3173, which also has a companion bill introduced in the Senate, cuts unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program. This particular bill, which has more than 340 bipartisan co-sponsors in the House and Senate, incorporates all the major elements of a 2018 consensus statement developed by leading physician, hospital, medical group, health plan and pharmacy stakeholders.

The House Ways and Means Committee ultimately introduced, marked up and passed a new, modified prior-authorization reform bill, H.R. 8487, “The Improving Seniors’ Timely Access to Care Act of 2022,” to address a variety of technical changes.

Specifically, the bill would:

  • Require Medicare Advantage plans to implement electronic prior-authorization programs that adhere to newly developed federal standards, as well as establish real-time decision-making processes for items and services that are identified as “routinely approved.”
  • Mandate that Medicare Advantage plans issue accelerated prior authorization decisions for all other services in Medicare Part C.
  • Enhance transparency by requiring Medicare Advantage plans report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals and denials.

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