Prior Authorization Reform Passed by U.S House; Moves to Senate for Further Action

Friday, September 30, 2022 11:35 AM | WiSCA (Administrator)

The Improving Seniors’ Timely Access to Care Act, federal legislation that would reform prior authorization in Medicare Advantage plans, was unanimously passed the U.S. House of Representative earlier this month and is now under further consideration by the Senate.

Providing much-needed oversight and transparency while protecting beneficiaries from unnecessary care delays and denials, the bill would require Medicare Advantage plans to:

·         Establish an electronic prior authorization program.

·         Standardize and streamline the prior authorization process for routinely approved services, including establishing a list of services eligible for real-time prior authorization decisions.

·         Ensure prior authorization requests are reviewed by qualified medical personnel.

·         Increase transparency around Medicare Advantage prior authorization requirements and their use.

Passage of this bipartisan bill was driven by more than 320 co-sponsors and over 500 endorsing organizations concerned over patient access to prompt care. In fact, a recently released report from the U.S. Department of Health and Human Services Office of Inspector General verified that some Medicare Advantage (MA) plans are inappropriately delaying and denying care.

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