Senator’s Improving Seniors’ Timely Access to Care Act improves access to care for seniors enrolled in Medicare Advantage (MA) by streamlining the prior authorization process for treatments and care their doctors prescribe
WASHINGTON – Arizona senior Senator Kyrsten Sinema, joined by U.S. Senators Roger Marshall (R-Kan.), Sherrod Brown (D-Ohio) and John Thune (R-S.D.), introduced the Improving Seniors’ Timely Access to Care Act — bipartisan legislation that streamlines and standardizes Medicare Advantage’s prior authorization process to ensure timely, quality care for Arizona seniors.
“We’re improving the authorization process so Arizona seniors with Medicare Advantage plans can receive timely and quality care, while lowering the costs and avoiding poorer clinical outcomes related to delayed care. Our bipartisan bill also allows doctors and health care providers to spend less time dealing with red tape and more time with their patients,” said Sinema.
Medicare Advantage plans often require “prior authorization” – a process which requires medical providers receive prior approval from the insurance company before prescribing medications or treatments and is often used to control costs. Patients and health care professionals have stressed that existing prior authorization processes are too slow – often denying orders made by medical professionals or delaying needed care to seniors. Sinema’s Improving Seniors’ Timely Access to Care Act modernizes the process through electronic prior authorization (e-PA), making it more efficient to meet the needs of patients, while maintaining quality of care and keeping costs low. The bill has been updated from previous congresses, after the Senators and their House co-leads successfully worked with the Centers for Medicare and Medicaid last year to implement parts of the original proposal through rulemaking.
The updated Improving Seniors’ Timely Access to Care Act would:
· Establish an e-PA process for MA plans, including a standardization for transactions and clinical attachments.
· Increase transparency around MA prior authorization requirements and their use.
· Clarify CMS’ authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and other PA 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.
Sinema’s legislation earned support from the Arizona Health Care Association, Arizona Society of Eye Physicians and Surgeons, Arizona State Neurological Society, and Southwest Medical Equipment Suppliers Association. Other national patient, provider, IT health, and medical device groups supporting the legislation include the Alzheimer’s Association, AARP, AdvaMed, American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, American Academy of Emergency Medicine, American Academy of Hospice and Palliative Care, American College of Cardiology, American College of Surgeons, American Nurses Association, Arthritis Foundation, Better Medicare Alliance, Epilepsy Foundation, National Alliance on Mental Illness, National Rural Health Association, LeadingAge, and more.