Image by oljamu from PixabayLegislation aiming to streamline the prior-authorization process under Medicare Advantage (MA) has been re-introduced in the Senate, with companion legislation also introduced in the House.
If enacted, it could enable more procedures to be conducted in ambulatory surgery centers (ASCs) by cutting through often restrictive red tape.
Obtaining prior authorization is often a hurdle for ASCs. Operators are required to approve certain services before they are provided, but since the use of prior authorization has increased substantially, there have been frequent errors in decision-making by MA plans.
Audits and investigations have revealed that many denied requests should have been approved, causing administrative burdens for providers and potential health risks for patients due to delays or denials in necessary care.
With endorsements from over 370 national and state organizations, the bipartisan Improving Seniors’ Timely Access to Care Act is expected to significantly reduce administrative burdens for providers and improve patient outcomes by expediting approval processes.
The bill establishes an electronic prior authorization (e-PA) system to streamline approvals, reducing reliance on outdated methods like faxes and phone calls. It mandates specific timeframes for prior-authorization decisions to expedite care delivery.
Additionally, the legislation increases reporting on prior-authorization practices, including approval and denial rates, to foster greater accountability. The bill also encourages Medicare Advantage plans to adopt policies aligned with evidence-based clinical guidelines.
“By passing the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, we can make it much easier for seniors to receive the care they’re entitled to while also alleviating unnecessary burdens on physicians and hospitals,” Congresswoman Suzan DelBene (D-Wash.), said in a press release.
The bill has been met with strong support from key health care industry groups, notably the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) and the American Hospital Association (AHA).
The AHA represents nearly 5,000 hospitals, health care systems and other providers, many of which are connected with ambulatory surgery centers.
“By removing unnecessary barriers that create delays in treatment, this meaningful bill will improve access to care for seniors and allow caregivers to spend more valuable time at the bedside with patients and less time on burdensome paperwork,” Stacey Hughes, AHA executive vice president, said in a press release.
Representing over 14,000 nursing homes and long-term care facilities, AHCA/NCAL has also expressed support for the bill. Nisha Hammel, AHCA/NCAL’s vice president of population health management, said the bill would help provide the clarity and transparency needed in Medicare Advantage to help beneficiaries choose their care.
“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,” she said.
