A recently reintroduced bipartisan bill would push health insurers to make “real-time” prior authorization determinations for Medicare Advantage (MA) beneficiaries. The bill, which was introduced by Rep. Suzan DelBene (D-Wash.) and co-sponsored by Reps. Mike Kelly (R-Pa.), Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.), incorporates feedback from both payer and provider stakeholder groups.
“When seniors need critical medical care, doctors and other health care providers should be spending their time working with patients instead of going back and forth on requests that should be electronic, standardized, and eventually automated,” said DelBene in a May 13 press release. “The majority of the health care community agrees that prior authorization needs to be reformed. This bipartisan legislation creates sensible rules for the road and will offer transparency and oversight to the prior authorization process.”
According to DelBene’s press release, the Improving Seniors’ Timely Access to Care Act would “establish an electronic prior authorization process, require HHS to establish a process for ‘real-time decisions’ for items and services that are routinely approved, improve transparency by requiring MA plans to report to CMS on the extent of their use of prior authorization and the rate of approvals or denials, [and] encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.”
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