Federal lawmakers Introduce Prior Authorization Bill

June 13, 2024

A bipartisan group of U.S. House and Senate leaders has reintroduced a key bill that would streamline prior authorization for Medicare Advantage plans.

The Improving Seniors’ Timely Access to Care Act would support the 1.4 million Pennsylvanians covered via Medicare Advantage. U.S. Representative Mike Kelly (R-PA) was among the elected leaders to introduce the bill.

In a statement, HAP President and CEO Nicole Stallings said: “The Improving Seniors' Timely Access to Care Act takes critical action to address the denial of care by Medicare Advantage plans. Prior authorizations delay and prevent patients from receiving the timely care they need and deserve. This bipartisan legislation will improve access to care for Pennsylvania seniors by removing barriers that delay essential medical care and reducing burden on providers.”

“HAP and Pennsylvania hospitals support and thank Representative Kelly for his leadership on this issue.”

The bill would:

• Establish an electronic prior authorization process for Medicare Advantage plans including a standardization for transactions and clinical attachments.
• Increase transparency for Medicare Advantage prior authorization requirements and its use.
• Clarify CMS’ authority to establish timeframes for electronic prior authorization requests including expedited determinations, real-time decisions for routinely approved items and services, and other 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.

“With over 33 million Americans enrolled in Medicare Advantage, modernization of the prior authorization process is long overdue,” Kelly said in a statement. “Lawmakers on both sides of the aisle, hundreds of health care organizations, Americans from all corners of the country agree—streamlining this process will allow our Nation’s seniors to receive the care they are entitled to more efficiently.

Additional Pennsylvania co-sponsors include Brian Fitzpatrick (R-PA), Dwight Evans (D-PA), John Joyce, M.D. (R-PA), Lloyd Smucker (R-PA), Dan Meuser (R-PA), Glenn Thompson (R-PA), Guy Reschenthaler (R-PA), Madeleine Dean (D-PA), Susan Wild (D-PA), and Senators Bob Casey (D-PA) and John Fetterman (D-PA).

HAP thanks members of the Pennsylvania delegation for their support of this important legislation. For additional information, contact John Myers, vice president, federal advocacy.