Reps. Bera, Kelly, DelBene, and Joyce Celebrate Milestone for Improving Seniors' Timely Access to Care Act

WASHINGTON, D.C. - Today, U.S. Representatives Ami Bera, M.D. (CA-06), Mike Kelly (PA-16), Suzan DelBene (WA-01), and John Joyce, M.D. (PA-13), leaders of H.R. 3514, the Improving Seniors' Timely Access to Care Act, released a joint statement after the legislation reached a significant milestone this week of 290 House cosponsors, an overwhelming bipartisan supermajority.

"We are incredibly pleased to see the Improving Seniors' Timely Access to Care Act reach this defining moment in the 119th Congress. This legislation puts patient care and patient outcomes first, and it will greatly modernize and streamline the prior authorization process," the Members said. "By passing the bipartisan, bicameral Improving Seniors' Timely Access to Care Act, we can make it much easier for seniors to receive the care they're entitled to while also alleviating unnecessary burdens on physicians and hospitals."

BACKGROUND

Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. But it's not without fault. The current system often results in unconfirmed faxes of a patient's medical information or phone calls by clinicians which takes precious time away from delivering quality and timely care.

Prior authorization continues to be the #1 administrative burden identified by health care providers, and three out of four Medicare Advantage enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.

More recently, HHS OIG released a report finding that MA plans incorrectly denied beneficiaries' access to services even though they met Medicare coverage rules.

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.

More than 35 million American seniors are enrolled in Medicare Advantage.

Specifically, the bill would:

• Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.
• Increase transparency around MA prior authorization requirements and its use.
• Clarify HHS' authority to establish timeframes for e-prior authorization requests including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.

The Improving Seniors' Timely Access to Care Act unanimously passed the House in the 117th Congress and was cosponsored by a majority of members in the Senate and House of Representatives.

The bill text can be found here and a section-by-section summary can be found here.