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Widely Supported Medicare Advantage Prior Authorization Bill Advances in House

Analysis  |  By Jay Asser  
   July 29, 2022

Several groups have backed the Seniors' Timely Access to Care Act, which will now head to the House floor.

The Seniors' Timely Access to Care Act continues to receive support as it moves to the full House after the House Ways and Means Committee unanimously voted to advance the bill.

The voice vote now tees up the legislation for a floor vote in the fall, with the bill receiving over 300 co-sponsors and the endorsement of over 500 organizations.

If passed, the bill would establish requirements and regulations for prior authorization under Medicare Advantage plans, such as establishing an electronic prior authorization program that includes the ability to provide real-time decisions in response to requests for items and services.

Several groups, from providers and payers alike, have advocated for the bill to improve the streamlining of the administrative process.

American Hospital Association (AHA):

"These policies to streamline MA prior authorization requirements by eliminating complexity and promoting uniformity would reduce the wide variation in prior authorizations methods that frustrate both patients and providers. Thank you for your support to improve the prior authorization process to increase patient access to care and reduce burden for providers."

American Medical Association (AMA):

"Most importantly, the additional sections of the legislation mandating MA plans to issue faster prior authorization decisions are crucial policy improvements that will ensure more timely access to care and, as a result, improved patient health care outcomes and better stewardship of scarce Medicare resources. The AMA supports the requirements for health plans to provide real-time prior authorization decisions for routinely approved services, as defined in implementing regulations."

Medical Group Management Association (MGMA):

“MGMA strongly supports the Improving Seniors’ Timely Access to Care Act of 2022," said Anders Gilberg, senior vice president of Government Affairs at MGMA. "If enacted, this legislation would significantly improve a prior authorization process that is overused, costly, onerous, inefficient, opaque, and, most critically, responsible for dangerous delays in the delivery of necessary patient care. By establishing an electronic prior authorization program for Medicare Advantage (MA) plans, medical groups will have less administrative burden and can appropriately focus attention back on the patient."

Better Medicare Alliance:

“H.R. 8487 will build on the work the Medicare Advantage community has already undertaken to modernize prior authorization while protecting its essential function in facilitating highvalue, clinically appropriate care," said Mary Beth Donahue, president and CEO of the Better Medicare Alliance. "We urge members of the Ways and Means Committee to vote ‘yes’ and look forward to continuing to partner with our bipartisan champions in Congress to secure passage of this bill on the House floor in short order.”

Jay Asser is the contributing editor for strategy at HealthLeaders. 

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