A group of bipartisan lawmakers last week reintroduced legislation seeking to improve the prior-authorization process within Medicare Advantage (MA).
Broadly, MA plans often require certain health-care services or supplies to be approved before delivered to Medicare beneficiaries. While the concept is meant to avoid unnecessary health-care costs, it frequently presents a paperwork challenge to providers and suppliers, including those in the home medical equipment (HME) space.
Prior authorization can pose even bigger problems for patients, too, when plans deny necessary and potentially crucial services.
The Improving Seniors’ Timely Access to Care Act hopes to eliminate some of the prior-authorization challenges that currently exist. Sens. Kyrsten Sinema (I-Ariz.), Roger Marshall (R-Kan.), Sherrod Brown (D-Ohio) and John Thune (R-S.D.) backed the bill in the Senate, with U.S. Reps. Mike Kelly (R-Penn.), Suzan DelBene (D-Wash.), Larry Bucshon (R-Ind.) and Ami Bera (D-Calif.) going to bat for the policy in the House.
“Right now, too many older Americans enrolled in Medicare Advantage are forced to deal with unnecessary delays when seeking out [care],” Sen. Brown said in a statement. “We need to update the Medicare Advantage program so it works better, faster, and is more transparent for patients and providers.”
The bipartisan, bicameral legislation specifically seeks to create an electronic prior authorization (e-PA) system to streamline approvals, which would, in turn, reduce reliance on outdated methods such as faxes and phone calls.
The legislation also mandates specific timeframes for prior-authorization decisions to expedite care delivery.
“By passing the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, we can make it much easier for seniors to receive the care they’re entitled to while also alleviating unnecessary burdens on physicians and hospitals,” Congresswoman Suzan DelBene (D-Wash.), said in a press release.
More than 370 national and state organizations have voiced their support for the Improving Seniors’ Timely Access to Care Act.
For context, MA plans made about 37.5 million prior-authorization determinations in 2021, which is about 1.5 determinations per enrollee, according to the Medicare Payment Advisory Commission (MedPAC).
