U.S. Sens. John Thune (R-S.D.) and Sherrod Brown (D-Ohio) this week introduced the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that requires private insurance companies that operate Medicare Advantage (MA) plans to establish an electronic prior authorization (ePA) system to approve medical services in a more timely manner. Implementing an electronic authorization program will reduce delays and help older Americans get quicker access to the treatment and care they need. The bill builds on legislation introduced in the U.S. House of Representatives last year by U.S. Reps. Suzan DelBene (D-Wash), Roger Marshall (R-Kan.), Ami Bera (D-Calif.), and Mike Kelly (R-Pa.).
Prior authorization can play a role in ensuring beneficiaries receive clinically appropriate treatments and help control the cost of care. However, when used improperly, prior authorization can lead to delays in care for patients and result in administrative burdens for providers. The Improving Seniors’ Timely Access to Care Act would help to streamline prior authorization processes, and promote safe, timely, and affordable access to evidence-based care for Medicare Advantage enrollees and the providers and suppliers who care for them.
“Modernizing and streamlining the prior authorization process is important for seniors and providers,” said Thune. “Our bipartisan legislation would ensure that everyone knows the rules of the road. It would also promote real-time decisions for routine services when feasible, making health care more efficient and patient-centered.”
“Older Americans shouldn’t be held up with unnecessary delays when seeking out medical treatment,” said Brown. “We should be updating our systems so that they work better and faster for patients and providers. Requiring private insurance companies to streamline prior authorization processes electronically will allow providers to quickly access the information they need to treat and care for their patients in a timely manner.”
In January 2019, health care industry leaders representing health care providers and health plans collaborated on a Consensus Statement on Improving the Prior Authorization Process, which identified important steps that can be taken to ensure safe, timely and affordable access to treatment. If passed, Brown and Thune’s legislation would take several key components from this consensus statement and advance them into law.
Specifically, the Improving Seniors’ Timely Access to Care Act would:
- Establish an electronic prior authorization process and require MA plans to adopt ePA capabilities;
- Require the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program;
- Standardize and streamline the prior authorization process for routinely approved items and services;
- Ensure prior authorization requests are reviewed by qualified medical personnel;
- Increase transparency around MA prior authorization requirements and their use; and
- Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
The House version of the bill has the support of nearly 280 members of Congress and has garnered more than 420 endorsements from a diverse group of outside stakeholders.
“The updated Senate companion to the Improving Seniors' Timely Access to Care Act is the product of months of bipartisan collaboration and is an example to all our colleagues on how Congress is supposed to work,” said DelBene. “With nearly two-thirds of the House and over 420 stakeholder organizations supporting the legislation, I am so pleased with the progress we have made since introduction. We will be focused on getting the bill across this finish line in the 117th Congress to make it easier for seniors to receive the care they need. Thank you, Representatives Mike Kelly, Roger Marshall, and Ami Bera, and Senators Sherrod Brown and John Thune. I couldn’t ask for a better team of legislators to work with on this important issue.”
“As a physician in rural Kansas, my top priority was always to provide quality care to every patient,” said Marshall. “I’ve carried that charge in Congress and helped introduce bipartisan legislation to modernize Medicare Advantage that will better serve America’s seniors. Over the past two years, my colleagues and I reviewed comments from nearly 450 national and state organizations. I am proud of our updated legislation and honored to have Senators John Thune and Sherrod Brown join us in this effort. This has been truly a bipartisan collaboration and I look forward to continue leading this charge next Congress.”
“Our updated legislation reflects improvements informed by all stakeholders—patients, providers, insurance plans, CMS, HHS ONC, and health technology experts,” said Bera. “Since we introduced the original version, 280 cosponsors have signed on. Now that our bipartisan House team is joined in this effort by Senators Brown and Thune, I am optimistic this bill advances in Congress next year and, when enacted, will lead to meaningful improvements for both patients and their health care providers.”
“Americans who are enrolled in Medicare Advantage plans sometimes face unnecessary delays in treatment and diagnoses, but this legislation will modernize the process of prior authorization so medical providers can offer them safe, timely, and affordable care,” said Kelly. “This common sense, bipartisan plan will give seniors peace of mind and improve America’s health care system. Thank you to my colleagues in the House and Senate for working with me on this vital legislation that will make a real difference in the lives of Medicare Advantage enrollees.