Shenango Valley News

U.S. Representatives Mike Kelly, Suzan DelBene, Larry Bucshon, and Ami Bera have announced that the Improving Seniors’ Timely Access to Care Act (H.R. 8702) has gained bipartisan support with over 218 cosponsors in the U.S. House of Representatives. This legislation aims to enhance care for seniors by refining how Medicare Advantage plans handle prior authorization while increasing oversight and transparency.

“With over 33 million Americans enrolled in Medicare Advantage, modernization of the prior authorization process is long overdue," stated the representatives. They emphasized the importance of streamlining this process to ensure that seniors receive their entitled care more efficiently. The lawmakers expressed gratitude for the bipartisan support and are eager to see the bill signed into law.

Prior authorization is a mechanism used by health plans to minimize unnecessary medical services by requiring pre-approval from healthcare providers. However, it often results in administrative burdens like unconfirmed faxes or phone calls that take time away from patient care. Currently, three out of four Medicare Advantage enrollees experience delays due to this process. An audit by the Office of the Inspector General at HHS found that 75% of initially denied requests were eventually approved, highlighting inefficiencies in the system.

The proposed bill would establish an electronic prior authorization process for Medicare Advantage plans and standardize transactions and clinical attachments. It seeks to increase transparency regarding prior authorization requirements and clarify CMS’s authority on timeframes for expedited determinations and real-time decisions for routinely approved items and services. Additionally, it aims to expand beneficiary protections and improve enrollee experiences.

The legislation previously passed unanimously in the House during the 117th Congress and was cosponsored by a majority in both Senate and House of Representatives. It has received backing from over 440 national and state organizations representing various stakeholders in healthcare.