June 13 :
Several members of Congress, including Indian-American Ami Bera, Suzan DelBene, Larry Bucshon, Mike Kelly, and Senators Roger Marshall, Kyrsten Sinema, John Thune, and Sherrod Brown, reintroduced the Improving Seniors' Timely Access to Care Act on June 12.
The goal of this bicameral and bipartisan bill is to simplify the Medicare Advantage (MA) prior authorization procedure so that seniors can get the treatment they need faster and doctors can put patients first instead of paperwork.
Congressman Bera, a former chief medical officer for Sacramento County, expressed his pleasure at introducing bipartisan, bicameral legislation that would codify protections to ensure that seniors can receive the medical care to which they are entitled, free from needless delays and denials caused by prior authorization. "Having worked in the medical field, I believe it is critical that we establish a system that allows doctors to spend less time dealing with a cumbersome prior authorization process and more time actually caring for their patients."
The Improving Seniors' Timely Access to Care Act was co-sponsored by the majority of lawmakers in both the House and the Senate and passed the House unanimously during the past Congress.
Health plans use prior authorization as a tool to reduce needless medical treatment by making healthcare providers get pre-approval for specific procedures. But there are some problems with the way things are right now. It frequently causes physicians to waste time calling patients or sending unconfirmed faxes with sensitive medical information, both of which take time away from providing timely, high-quality care. According to a statement by Bera, healthcare providers continue to rank prior authorization as the top administrative burden. Additionally, a significant number of Medicare Advantage subscribers encounter needless delays as a result of this requirement.
A recent audit by the US Department of Health and Human Services' Office of the Inspector General revealed that Medicare Advantage plans granted 75% of initially denied claims. This caused worries inside the agency. A more recent investigation by the HHS Office of Inspector General revealed that MA plans wrongfully denied beneficiaries access to services, even though they were eligible for Medicare.
The bill's goal is to standardise transactions and clinical attachments by instituting an electronic prior authorization (e-PA) procedure for Medicare Advantage (MA) plans. Its stated goal is to more openly discuss and apply prior authorization rules in MA. In addition, it would make it clear that the CMS has the power to establish timelines for electronic prior authorization requests, such as accelerated decisions and real-time approvals for commonly approved items and services. To improve enrollee experiences and outcomes, the bill also aims to broaden beneficiary safeguards. In addition to enhancing the e-PA process, it would require the HHS and other relevant agencies to report to Congress on their efforts to ensure programme integrity.
