Congressional Corner: Significant Milestone for Improving Seniors’ Timely Access to Care Act
By Representative Ami Bera (CA-06)
I am pleased to share that H.R. 3514, the Improving Seniors’ Timely Access to Care Act, recently reached a significant milestone of 290 House cosponsors, demonstrating overwhelming bipartisan support in the House of Representatives. I am proud to lead this legislation alongside Representatives Mike Kelly (PA-16), Suzan DelBene (WA-01), and John Joyce, M.D. (PA-13) to modernize the prior authorization process, reduce unnecessary delays in care, and ensure seniors can access the healthcare they need in a more timely manner.
This legislation puts patient care and outcomes first. By passing the bipartisan Improving Seniors’ Timely Access to Care Act, we can make it easier for seniors to receive the care they are entitled to while alleviating unnecessary administrative burdens on physicians and hospitals.
Prior authorization continues to be the #1 administrative burden identified by health care providers, and three out of four Medicare Advantage (MA) enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75 percent of requests that were originally denied.
More recently, the HHS Office of Inspector General released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.
Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.
More than 35 million American seniors are enrolled in Medicare Advantage.
Specifically, the bill would:
- Establish an electronic prior authorization process for MA plans, including a standardization for transactions and clinical attachments.
- Increase transparency around MA prior authorization requirements and their use.
- Clarify HHS’ authority to establish timeframes for e-prior authorization requests, including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
- Expand beneficiary protections to improve enrollee experiences and outcomes.
- Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.
The Improving Seniors’ Timely Access to Care Act passed the House unanimously in the 117th Congress and was cosponsored by a majority of members in both the Senate and the House of Representatives.
Statements contained in this article are those of the writer and do not necessarily reflect the position of The Senior Citizens League (TSCL).
