Bipartisan legislation would reform prior authorization process to make it easier for seniors to get the care they need
WASHINGTON — Today, Congresswoman Cheri Bustos (IL-17), voted to pass the Improving Seniors’ Timely Access to Care Act, legislation that would make it easier for Illinois seniors to get the health care they need. The bill would modernize the antiquated prior authorization process in Medicare Advantage, which often still requires faxing documents to insurance companies.
“When seniors go to the doctor, the focus should be on their health, not red tape,” said Congresswoman Bustos. “Today, I voted to pass bipartisan legislation to reform the prior authorization process in Medicare Advantage so seniors in Northwest and Central Illinois can get the care they need, when they need it.”
Many Medicare Advantage plans require providers to obtain prior authorization for certain medical procedures and tests before they can provide care to their patients. Prior authorization can play a role in ensuring people receive appropriate treatments and help control the cost of care. However, when misused, prior authorization can delay medically necessary care and result in administrative burdens for providers.
The Improving Seniors’ Timely Access to Care Act would:
- Establish an electronic prior authorization process.
- Require the U.S. Department of Health & Human Services (HHS) to establish a process for “real-time decisions” for items and services that are routinely approved.
- Improve transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services (CMS) on the extent of their use of prior authorization and the rate of approvals or denials.
- Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.
Earlier this year, HHS’s independent watchdog released a report illustrating the abuse of prior authorization in Medicare Advantage.
The legislation was introduced by Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera, M.D. (CA-07), and Larry Bucshon, M.D. (IN-08). It has over 300 cosponsors in the House, including Congresswoman Bustos, and the endorsement of over 500 organizations.
In July, the House Ways & Means Committee advanced the bill to the floor. The bill now goes to the Senate for consideration where it also has strong bipartisan support.
A fact sheet on the Improving Seniors’ Timely Access to Care Act can be found here.