Shenango Valley News

U.S. Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Larry Bucshon, M.D. (R-IN), and Ami Bera, M.D. (D-CA) along with U.S. Senators Roger Marshall, M.D. (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), and Sherrod Brown (D-OH) have reintroduced the Improving Seniors’ Timely Access to Care Act. This bipartisan legislation aims to streamline the prior authorization process under Medicare Advantage, facilitating quicker access to care for seniors and reducing administrative burdens on healthcare providers.

“With over 33 million Americans enrolled in Medicare Advantage, modernization of the prior authorization process is long overdue,” said Representative Mike Kelly. He emphasized that streamlining this process would allow seniors to receive their entitled care more efficiently.

Congresswoman Suzan DelBene added, “We’ve made important incremental headway in helping seniors get the medical care they deserve with the administration’s prior authorization regulations. However, we must go further and enshrine these advancements into law.”

Congressman Dr. Larry Bucshon highlighted that an inefficient prior authorization process creates unnecessary paperwork and delays critical procedures for patients: “As a physician, I believe the best approach to solving challenges with our health care system is to put the patient first.”

Congressman Ami Bera noted his experience as a Chief Medical Officer: “It is crucial we create an environment where physicians can spend less time with an antiquated prior authorization system and more time taking care of their patients.”

Senator Roger Marshall pointed out that prior authorization is a significant administrative burden for physicians across all specialties: “With the bipartisan Improving Seniors’ Timely Access to Care Act, we will streamline prior authorization and help improve patient outcomes.”

Senator Kyrsten Sinema stated that improving the authorization process would ensure timely and quality care for Arizona seniors while reducing costs related to delayed care.

Senator John Thune remarked on the necessity of modernizing and streamlining the process for South Dakota seniors: “This bipartisan legislation would remove unnecessary red tape.”

Senator Sherrod Brown stressed updating Medicare Advantage so it works better for patients: “By requiring private insurance companies to streamline prior authorization processes electronically, we can ensure providers can quickly access information needed for patient care.”

Prior authorization requires healthcare providers to obtain pre-approval from health plans before delivering services, often leading to delays due to unconfirmed faxes or phone calls by clinicians. The Office of Inspector General at HHS has raised concerns about MA plans denying services initially only to approve them later upon appeal.

The bill proposes establishing an electronic prior authorization process for MA plans including standardization of transactions and clinical attachments; increasing transparency around MA requirements; clarifying CMS' authority on timeframes for e-PA requests; expanding beneficiary protections; and mandating reports from HHS on program integrity efforts.

The bill has garnered support from over 370 national and state organizations representing various stakeholders in healthcare.