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Indian-American Congressman Ami Bera reintroduces Improving Seniors’ Timely Access to Care Act
The bipartisan, bicameral legislation streamlines the prior authorization process under Medicare Advantage (MA).
Indian-American lawmaker Ami Bera. / Ami Bera website
Indian-American Congressman Ami Bera along with his colleagues Suzan DelBene, Larry Bucshon, Mike Kelly, and Senators Roger Marshall, Kyrsten Sinema, John Thune, and Sherrod Brown, reintroduced on June.12 the Improving Seniors’ Timely Access to Care Act.
This bipartisan and bicameral legislation aims to streamline the prior authorization process under Medicare Advantage (MA), ensuring that seniors can access the care they need promptly and allowing healthcare providers to prioritize patients over paperwork.
Today, I reintroduced the Improving Seniors’ Timely Access to Care Act with my colleagues.
— Ami Bera, M.D. (@RepBera) June 12, 2024
I'm proud of the incremental progress we've made so far, but, we must go further and codify these advancements into law. pic.twitter.com/fqSmYPK6ur
“I am pleased to introduce this bipartisan, bicameral legislation that will codify protections to help seniors access the medical care they are entitled to without unnecessary delays and denials due to prior authorization," said Congressman Bera, who previously served as Chief Medical Officer for Sacramento County. “Having practiced in medicine, it is crucial we create an environment where physicians can spend less time with an antiquated prior authorization system and spend more time taking care of their patients.”
During the last Congress, the Improving Seniors’ Timely Access to Care Act passed the House unanimously and received co-sponsorship from a majority of members in both the Senate and the House of Representatives.
Prior authorization is a mechanism utilized by health plans to curb unnecessary medical care by requiring healthcare providers to obtain pre-approval for certain medical services. However, the current system is not without its flaws. Often, it leads to unconfirmed faxes containing a patient’s medical information or time-consuming phone calls by clinicians, diverting valuable time away from providing quality and timely care. It remains the top administrative burden identified by healthcare providers, and three out of four Medicare Advantage enrollees experience unnecessary delays due to prior authorization, a statement by Bera said.
In recent years, the Office of the Inspector General at the US Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75 percent of requests that were initially denied. More recently, an HHS OIG report found that MA plans incorrectly denied beneficiaries access to services even when they met Medicare coverage rules.
The bill would establish an electronic prior authorization (e-PA) process for Medicare Advantage (MA) plans, introducing standardization for transactions and clinical attachments. It aims to enhance transparency surrounding MA prior authorization requirements and their application. Moreover, it would clarify the Centers for Medicare & Medicaid Services (CMS) authority to set timeframes for e-PA requests, including expedited determinations and real-time decisions for routinely approved items and services, as well as other prior authorization requests.
Additionally, the legislation seeks to expand beneficiary protections to enhance enrollee experiences and outcomes. It would also mandate that the Department of Health and Human Services (HHS) and other relevant agencies report to Congress on program integrity efforts and explore further avenues to improve the e-PA process.
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