House Unanimously Passes Bill to Improve Care for Seniors

WASHINGTON — The House on Wednesday unanimously passed the Improving Seniors’ Timely Access to Care Act, legislation that would make it easier for seniors to get the care they need by modernizing the antiquated “prior authorization” process in Medicare Advantage.

The bill, which now heads to the Senate, is expected to ultimately improve the lives of some 28 million seniors who are enrolled in the Medicare Advantage program.

Medicare Advantage plans require providers to obtain prior authorization for certain medical procedures and tests before they can provide care to their patients. Prior authorization can play a role in ensuring people receive appropriate treatments and help control the cost of care. However, when misused, prior authorization can delay needed medical interventions and result in administrative burdens for providers.

The House bill, also known as HR 3173, would:

• Establish an electronic prior authorization process.
• Require the U.S. Department of Health & Human Services to establish a process for “real-time decisions” for items and services that are routinely approved.
• Improve transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials.
• Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

The bipartisan legislation was led in the House by Reps. Suzan DelBene, D-Wash., Mike Kelly, R-Penn., Ami Bera, D-Calif., and Larry Bucshon, R-Ind.

Both Bera and Bucshon are also medical doctors. The bill had over 320 cosponsors in the House and the endorsement of over 500 organizations.

A fact sheet on the Improving Seniors’ Timely Access to Care Act can be found here.

Dan can be reached at [email protected] and @DanMcCue