Nursing home and senior living providers on Friday praised the newly introduced Improving Seniors’ Timely Access to Care Act, which would address the longstanding issue of prior authorization required by Medicare Advantage (MA) plans.
“This bill helps provide the clarity and transparency needed in Medicare Advantage to help beneficiaries feel more confident that they are receiving the level of high-quality and timely care they need and deserve,” Nisha Hammel, vice president of population health management at the American Health Care Association/National Center for Assisted Living, said in a statement supporting the bill. “Using modern methods of electronic prior authorizations, while still having proper oversight and guidelines, can offer a better experience for both beneficiaries and care providers as the use of MA plans continues to become more prevalent in long term and post-acute care.”
While prior authorization is meant to reduce unnecessary care, the current system often results in multiple clinician-generated communications, taking valuable time away from delivering care. Nearly 31 million seniors enrolled in MA plans can face delays due to the prior authorization practice. A report by the Department of Health and Human Services (HHS) revealed that MA plans ultimately approved 75% of requests that were initially denied, indicating a need for improvement in the process.
The proposed legislation would establish an electronic prior authorization process for MA plans, including standardization for transactions and clinical attachments. The process would increase transparency around prior authorization requirements and their use, and clarify the Department of Health and Human Services’ authority to establish time frames for expedited determinations, real-time decisions for routinely approved services, and other prior authorization requests.
The Improving Seniors’ Timely Access to Care Act has broad support from members of Congress, with 130 House representatives and 42 senators co-sponsoring the bill. More than 370 national and state organizations representing patients, physicians, MA plans, hospitals and other key stakeholders in the healthcare industry also have endorsed the legislation.
