The Improving Seniors' Timely Access to Care Act enhances elements of a final rule mandating Medicare Advantage plans expedite the prior authorization process
Dec. 6, 2024 (ACP) -- The 麻豆直播app is urging Congress to take immediate action to support legislation that aims to streamline the prior authorization (PA) approval process in Medicare Advantage (MA) plans and reduce administrative burdens associated with this process.
鈥淭he Improving Seniors' Timely Access to Care Act would codify and enhance elements of a final rule issued by the Biden administration that mandates MA plans expedite the timeline for prior authorization approval,鈥 said Brian Buckley, ACP senior associate for legislative affairs. 鈥淎CP members should their representatives in the House and Senate and urge them to pass this bill before Congress adjourns at the end of the year.鈥
The legislation was initially introduced in Congress in 2019. After it stalled, the Biden administration reformed PA policies within MA on its own through the rule-making process.
ACP was pleased by the improvements to PA procedures but wants Congress to build on the rule and make the changes permanent. 鈥淲hile we do not expect the Trump administration to reverse this rule, enactment of the legislation would provide assurance that it could only be changed by Congress in the future,鈥 Buckley said.
The current bill has been slightly adjusted to align with the Biden administration's changes. It now includes a requirement for the Centers for Medicare & Medicaid Services to issue a report on implementing real-time decisions plus an analysis on enrollee impact and clarification of the authority of CMS to modify the time frames for making PA determinations.
The bill also:
- mandates that all MA plans adopt electronic capabilities to streamline the process for PA approval;
- protects beneficiaries from any disruptions in care due to PA requirements as they transition between MA plans;
- standardizes the process and procedures for reporting electronic PA criteria to MA plans and mandates that all MA plans issue PA decisions more promptly;
- ensures PA requests are reviewed by qualified medical personnel; and
- increases transparency around PA requirements.
The bill would also improve transparency requirements in the PA approval and denial process by requiring information, such as the numbers of specified requests that were denied or approved by plans during the previous plan year.
As Buckley notes, the revised bill now has a 鈥渮ero score鈥 from the Congressional Budget Office, which means it is estimated to cost nothing. This is because the Biden administration already implemented much of it.
鈥淲e hope that the zero score assigned to this bill will improve the chances of its passage before the end of the year,鈥 Buckley said. 鈥淚f it is not passed by the end of this calendar year, it would need to be reintroduced in the 119th Congress.鈥
More Information
Resources for ACP members to urge Congress to pass prior authorization legislation this year are available in the .
Back to the December 6, 2024 issue of ACP Advocate