Bipartisan support in Congress is building for one of ACAAI’s key legislative advocacy priorities. The Improving Seniors’ Timely Access to Care Act, which would streamline the prior authorization process for recipients of Medicare Advantage plans, now has more than 290 House co-sponsors and 28 Senate co-sponsors.
The legislation would require Medicare Advantage plans to streamline and to be more transparent about the results of their prior authorization processes.
Perhaps most notably, the bill requires Medicare Advantage plans to create an electronic prior authorization process that provides real-time responses to prior authorization requests for services that are regularly approved. In addition, Medicare Advantage plans must publish yearly prior authorization information, including the percentage of requests approved and the average response time. The bill gives authority to CMS to determine other standards that address the timeliness and quality of prior authorization determinations.
Provider groups have been advocating aggressively for prior authorization reforms, the need for which were supported by a recent HHS OIG report which found that 13% of prior authorizations denied by insurance companies met Medicare coverage rules. In addition, plans made burdensome requests for documentation and made errors in processing the requests. The report raised concerns about incorrect handling of prior authorizations adversely affecting access to care.
The OIG report’s findings emphasize the urgency of pursuing these reforms and have fueled support for the Improving Seniors’ Timely Access to Care Act.
The House version of the bill has 292 co-sponsors – more than two-thirds of the House of Representatives. It has not been scheduled for a floor vote, as of the time of this writing. The Senate version of the bill was introduced in late 2021 by Senator Roger Marshall (R-KS). The Senate bill has 28 co-sponsors, and some of them have referenced the findings in the HHS OIG report as a motivating factor for supporting the legislation.
In addition to ACAAI, more than 470 organizations have endorsed the Senate version, while 371 have endorsed the House version. We’ll continue to monitor and report on this issue as it moves through the legislative process.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
