Shenango Valley News

WASHINGTON, D.C. -- In June, U.S. Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Larry Bucshon, M.D. (R-IN), and Ami Bera, M.D. (D-CA) alongside U.S. Senators Roger Marshall, M.D. (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), and Sherrod Brown (D-OH) introduced the Improving Seniors’ Timely Access to Care Act. The bipartisan legislation aims to streamline the prior authorization process under Medicare Advantage (MA) to enhance timely care for seniors while reducing administrative burdens on healthcare providers.

Since its introduction, the bill has garnered support from over 400 national and state organizations representing various stakeholders in the healthcare industry.

Peggy Tighe of Powers Law stated, “We are honored to work with the Regulatory Relief Coalition (RRC)... This bipartisan, bicameral, non-controversial, and widely supported legislation is one of the most widely supported health care bills in the 118th Congress.”

Debra Youngfelt of the Pennsylvania Rural Health Association emphasized the impact on rural residents: “We know that delays in care can lead to significant health outcomes for older rural residents... The Pennsylvania Rural Health Association applauds efforts to streamline the approval process for seniors enrolled in Medicare Advantage programs.”

Mary Beth Donahue from Better Medicare Alliance noted widespread beneficiary concerns: “Prior authorization is an important tool in Medicare Advantage... With more than 33 million seniors now choosing Medicare Advantage, this work is more urgent and necessary than ever.”

Nicole Stallings of HAP remarked on access issues: “Prior authorizations delay and prevent patients from receiving timely care... HAP and Pennsylvania hospitals support and thank Representative Kelly for his leadership on this issue.”

Alan Morgan of NRHA highlighted challenges faced by rural facilities: “The current Medicare Advantage prior authorization process obstructs appropriate care... The National Rural Health Association is grateful to Senator Marshall for introducing legislation which will update, clarify, and add transparency to this process.”

Molly Guthrie from Susan G. Komen addressed breast cancer treatment delays: "Unnecessary delays caused by burdensome prior authorization requirements can be costly... We urge Congress to act swiftly."

Bruce A. Scott of AMA stressed urgency: "Our patients know all too well that prior authorization needs a dramatic overhaul."

Dr. Ali Khan from Aetna added insights on provider experiences: "Modernizing prior authorization in Medicare Advantage will benefit everyone."

Stacey Hughes of AHA pointed out systemic inefficiencies: “By removing unnecessary barriers that create delays in treatment... this meaningful bill will improve access to care for seniors.”

Katie Smith Sloan of LeadingAge called for accountability: "Positive change is urgently needed; the Improving Seniors’ Timely Access to Care Act will achieve it."

Dr. Kate Goodrich from Humana endorsed ePA benefits: "We are encouraged that the bill promotes expediting approvals through greater adoption of electronic prior authorization."

William Dombi from NAHC criticized current processes as unreliable: "The Act will go a long way to rectifying these concerns and protecting seniors when they need essential health care."

Bob Carlstrom from AMAC Action praised bureaucratic reductions: "This crucial legislation will streamline the prior authorization process under Medicare Advantage."

Hal Wolf from HIMSS emphasized administrative simplification benefits: “It is a breath of fresh air for everyone who has ever tried to navigate this complicated process.”

Joseph Alhadeff from Physician-Led Healthcare advocated for physician empowerment: "Increasing transparency...will help empower physicians to do what they do best—take care of their patients."

Josephine Gallagher from Free2Care urged swift legislative action due to life-threatening consequences caused by delays.

Steve Hentzen expressed gratitude towards legislative improvements benefiting those undergoing difficult treatments.

Background information provided highlights that three out of four MA enrollees face unnecessary delays due to current prior authorization practices which have been criticized by recent HHS OIG reports.

The bill proposes establishing an electronic PA process including standardization transactions and clinical attachments; increasing transparency; clarifying CMS authority; expanding beneficiary protections; requiring agency reports on program integrity efforts among other improvements.

Rep. Kelly led similar efforts previously with unanimous House passage during last Congress.

For further details or full text references:

- Bill text available [here].

- Section-by-section summary [here].

- Support list as updated [here].

- More information about the bill [here].

---