This legislation is the culmination of months of bipartisan, bicameral discussions that included full engagement with all involved stakeholders, resulting in balanced, common-sense legislation that would help protect patients from unnecessary delays in care by streamlining and standardization of prior authorization in the Medicare Advantage (MA) program.
What is Prior Authorization?
Prior authorization is a cumbersome process that requires physicians to obtain pre-approval for medical treatments or tests before rendering care to their patients. The process for obtaining this approval is lengthy and typically requires physicians or their staff to spend the equivalent of 2 or more days each week negotiating with insurance companies — time that would be better spent taking care of patients.
I urge you to tell Congress to bring needed transparency and oversight to the MA program by adopting the Improving Seniors’ Timely Access to Care Act. This legislation would:
- Establish an electronic prior authorization (ePA) program and require MA plans to adopt ePA capabilities
- Require the Secretary of Health and Human Services to establish a list of items and services eligible for real-time decisions under an MA ePA program
- Standardize and streamline the prior authorization process for routinely approved items and services
- Ensure prior authorization requests are reviewed by qualified medical personnel
- Increase transparency around MA prior authorization and its use
- Protect beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans.
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