Congress introduces prior authorization legislation

Many seniors experience delays in receiving essential medical care due to the prior authorization requirements imposed by Medicare Advantage (MA) plans. These requirements not only delay care but also create a significant administrative burden for physicians, diverting valuable time from patient care to paperwork. Thanks to our dedicated advocacy efforts, Congress has recently introduced the Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4518), aimed at alleviating these challenges by simplifying the prior authorization process for MA plans. This bipartisan bill proposes to:

Implement an electronic prior authorization system for MA plans, including standardized transactions and clinical attachments.
Enhance transparency regarding MA prior authorization requirements and their application.
Define the Centers for Medicare & Medicaid Services’ (CMS) authority to set timeframes for electronic prior authorization requests, ensuring expedited determinations, real-time decisions for commonly approved items and services and timely responses to other authorization requests.
Strengthen beneficiary protections to enhance enrollee experiences and outcomes.
Mandate the U.S. Department of Health and Human Services (HHS) and other relevant agencies to report to Congress on efforts to maintain program integrity and explore additional improvements to the electronic prior authorization process.

This bipartisan legislation had 378 cosponsors last cycle and even passed the U.S. House of Representatives. The AOA is eager to continue the momentum and success of last cycle into 2024 and will take additional action to help advance this important bill.