North Charlotte Today

Senator Thom Tillis recently joined a bipartisan group of Senators in reintroducing the Improving Seniors’ Timely Access to Care Act. This bipartisan, bicameral legislation aims to streamline the prior authorization process under Medicare Advantage (MA), facilitating timely care for seniors and reducing administrative burdens on health care providers.

“Arbitrary and unnecessary delays in care that stem from current prior authorization processes are unacceptable,” said Senator Tillis. “This legislation will alleviate administrative burdens on physicians, cut red tape and, most importantly, ensure patients have uninterrupted access to quality care.”

Prior authorization is used by health plans to reduce unnecessary care by requiring pre-approval for medical services. However, the current system often results in unconfirmed faxes or phone calls that take time away from delivering quality and timely care. Prior authorization remains the primary administrative burden identified by health care providers, with three out of four Medicare Advantage enrollees experiencing unnecessary delays due to this process.

The Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests initially denied. More recently, HHS OIG released a report indicating that MA plans incorrectly denied beneficiaries’ access to services despite meeting Medicare coverage rules.

Health plans, providers, and patients agree that improving the prior authorization process is essential. Leading health care organizations have released a consensus statement addressing major concerns associated with prior authorization.

The bill proposes:

- Establishing an electronic prior authorization process for MA plans including standardization for transactions and clinical attachments.

- Increasing transparency around MA prior authorization requirements.

- Clarifying CMS’ authority to establish timeframes for e-PA requests including expedited determinations and real-time decisions for routinely approved items.

- Expanding beneficiary protections to improve enrollee experiences and outcomes.

- Requiring HHS and other agencies to report to Congress on program integrity efforts and ways to improve the e-PA process further.

This legislation has garnered support from over 370 national and state organizations, including the North Carolina Medical Society, Susan G. Komen Foundation, National Council for Mental Wellbeing AARP, National Association for Home Care & Hospice, National Alliance on Mental Illness, Alzheimer's Association, and American Hospital Association.

Bill text is available HERE.

A section-by-section summary can be found HERE.

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