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Medical Groups Applaud House for Passing MA Prior Authorization Bill

Analysis  |  By Jay Asser  
   September 16, 2022

The Improving Seniors' Timely Access to Care Act, on the strength of overwhelming support, now heads to the Senate.

The widely-supported legislation that aims to reform prior authorization in Medicare Advantage (MA) plans has been unanimously passed in the House, a decision advocated by several medical groups.

Now on its way to the Senate, the Improving Seniors' Timely Access to Care Act is one step closer to establishing an electronic prior authorization program to streamline requests for services under MA plans, which would help mitigate unnecessary denials or delays in care.

MA plans have been under scrutiny of late for their prior authorization processes, with a recent report by the Office of Inspector General finding that MA organizations often delay or deny services for medically necessary care, even when coverage rules are met.

As well as potentially resulting in negative outcomes for patients, unnecessary prior authorization also creates administrative burden for providers.

Several medical groups have already offered recommendations on improving the process and following the House vote to advance the bill, the associations reiterated the importance of prior authorization reform.

Related: Widely Supported Medicare Advantage Prior Authorization Bill Advances in House

Stacey Hughes, executive vice president of the American Hospital Association: "This legislation takes important steps to reduce the burden and complexity of prior authorization requirements imposed by Medicare Advantage plans. These provisions will help Medicare patients access the care they need in a timely manner while reducing the strain on our already taxed health care workforce."

Jack Resneck, president of the American Medical Association: "The House recognized that prior authorization is an insurance companies' practice that is overused, costly, opaque, burdensome to physicians, and harmful to patients due to delays in care. The American Medical Association is committed to fixing prior authorization and made doing so a central plank of our Recovery Plan for America's Physicians."

Anders Gilberg, senior vice president of Government Affairs for the Medical Group Management Association: "The transparency provisions included in this legislation — requiring MA plans to publicly reveal what services are subject to prior authorization, how many are approved, and how long on average they take to approve — will drive plan accountability. By streamlining and standardizing the overly cumbersome and wildly inefficient MA prior authorization process, this legislation will return a focus to the physician-patient relationship and prevent dangerous delays to timely care."

Jay Asser is an associate editor for HealthLeaders.


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