If the newly reintroduced bipartisan bill, Improving Seniors’ Timely Access to Care Act, becomes law, it would streamline the prior authorization process, allowing providers to spend more time on patient care rather than administrative work.
U.S. Senators Roger Marshall, M.D. (R-Kan.) and Mark Warner (D-Va.) this week reintroduced legislation to improve access to care for the 32.8 million seniors enrolled in Medicare Advantage (MA) plans. It aims to streamline the prior authorization process to allow health care providers to focus on patient care, rather than cumbersome and time-consuming prior authorization requirements.
Physicians have complained that prior authorization, a prior approval process for medical services that insurers use to manage health care utilization and control costs, can wreak havoc on patient care. A survey conducted by the American Medical Association in December 2023 found the process creates barriers that can lead to serious or life-threatening events for patients, unnecessary waste, and physician burnout.
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“Prior authorization is the number one administrative burden facing physicians today across all specialties,” Marshall said in an announcement. “As a physician, I understand the frustration this arbitrary process is causing health care practices across the country and the headaches it creates for our nurses.”
Warner said that the legislation takes commonsense steps to modernize the prior authorization process, cutting through red tape, streamlining approvals, and making sure health care providers focus on what really matter— supporting their patients.
The senators said the bill would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that the Centers for Medicare & Medicaid Services (CMS) finalized on January 17, 2024.
Last Congress, the bill was supported by a supermajority of members in the Senate (60) and a majority in the House (232) and was unanimously passed by the House in 2022. The senators pointed to a 2018 Office of Inspector General (OIG) audit that found Medicare Advantage (MA) plans ultimately approved 75 percent of requests that were originally denied.
A 2022 OIG report found plans sometimes delayed or denied MA beneficiaries’ access to services even when the requests met Medicare coverage rules. Among the prior authorization requests that the plans denied, 13 percent met Medicare coverage rules. These services likely would have been approved for these MA beneficiaries under original Medicare.