Senate Bill Speeds Prior Authorization for Medicare Advantage Plans

WASHINGTON, D.C. (November 23, 2021)—Bipartisan legislation introduced in the United States Senate would ease, standardize and speed the process of prior authorization in Medicare Advantage plans.

The Improving Seniors’ Timely Access to Care Act would automate the prior authorization process in Medicare Advantage (MA) plans through electronic submission of prior authorization requests with real-time determinations by the MA plans. The legislation encourages integration of the electronic prior authorization submission into electronic medical record systems.

The Secretary of Health and Human Services would be tasked with developing standards in conjunction with stakeholder input. In addition, certain transparency requirements would be put in place. These include:

• A list of services and items subject to prior-authorization;
• The percentage of prior authorization requests approved during the previous plan year by the plan for each item and service;
• The percentage of requests that were initially denied and then subsequently appealed, and the percentage of such appealed requests that were overturned for each such item and service; and
• The average amount of time elapsed from request submission to determination.

This legislation would impact all provider types that contract with Medicare Advantage plans subject to prior authorization.

Introduced by Senator Roger Marshall (R-Kansas), Kyrsten Sinema (D-Arizona), John Thune (R-South Dakota), and Sherrod Brown (D-Ohio), the Improving Seniors’ Timely Access to Care Act is a companion bill to legislation of the same name previously introduced in the House of Representatives. The House version is led by Representatives Suzan DelBene (D-Washington) and Mike Kelly (R-Pennsylvania) and currently enjoys the co-sponsorship of 239 members of Congress.

—VIA NAHC