Skip to main content

Medicare Advantage Advocate Endorses Prior Authorization Bill

Analysis  |  By Jay Asser  
   May 27, 2022

The Improving Seniors' Timely Access to Care Act would set standards for prior authorization to cut down on unnecessary denials.

Better Medicare Alliance has thrown its support behind the Improving Seniors' Timely Access to Care Act, a bill that strives to improve prior authorization processes for Medicare Advantage (MA) plans.

The bipartisan legislation, which has also been backed by several provider and patient advocacy groups, is set up to be considered by the House of Representatives after surpassing 290 co-sponsors.

"When it comes to the use of medical management tools like prior authorization, Better Medicare Alliance has always worked on two tracks: seeking to increase understanding about the role of prior authorization in facilitating high-value, clinically appropriate care, while also working to simplify this process for patients and providers alike," said Mary Beth Donahue, president and CEO of Better Medicare Alliance.

"The Improving Seniors' Timely Access to Care Act is a commonsense solution that builds on the work the Medicare Advantage community has been doing to streamline prior authorization for seniors."

Better Medicare Alliance's endorsement of the bill comes on the heels of a report by the Office of Inspector General that found Medicare Advantage organizations (MAOs) often unnecessarily deny prior authorizations.

According to the report, 13% of prior authorization denials met Medicare coverage rules and 18% of payment denials met Medicare coverage and MAO billing rules.

Donahue stated that Better Medicare Alliance is looking forward to working CMS to implement electronic prior authorization process to ensure seniors aren't inappropriately denied necessary care.

In turn, the lead sponsors of the bill are eager to work with Better Medicare Alliance to pass the legislation.

"We welcome the Better Medicare Alliance's support of these reforms and look forward to working with them to get this bill signed into law," said representatives Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera (D-Calif.), and Larry Bucshon (R-Ind.).

Jay Asser is the contributing editor for strategy at HealthLeaders. 

Get the latest on healthcare leadership in your inbox.