House committee advances bill to install new prior authorization reforms for Medicare Advantage

A key House panel advanced legislation to create an electronic prior authorization process for Medicare Advantage plans and several other reforms.

The House Ways and Means Committee unanimously advanced on Wednesday the Improving Seniors Timely Access to Care Act of 2022. The legislation has more than 300 co-sponsors and wide support across the healthcare industry.

“The health care system is complicated in the best of times,” said Rep. Suzan DelBene, D-Washington, one of the leading co-sponsors, in a statement. “Doctors and their patients shouldn’t have to call or fax back and forth with insurance companies or send documents multiple times for procedures that are approved over 95 percent of the time.”

The legislation would require the Department of Health and Human Services to create a process for faster, real-time decisions on prior authorization requests for items or services that routinely get approval. Insurers rely on prior authorization to help control costs, especially for newer and pricier treatments.

MA plans would also have to report to the Centers for Medicare & Medicaid Services on how much they use prior authorization and the approval/denial rates. 

Plans would be encouraged to adopt prior authorization processes that adhere to key evidence-based guidelines crafted in consultation with physicians, according to a release on the legislation.

“This legislation moves the health care sector into the 21st century by giving doctors and Medicare Advantage plans the tools to make health coverage decisions in real-time,” said Rep. Mike Kelly, R-Pennsylvania, another lead co-sponsor. 

The legislation is expected to reach the House floor in the fall after lawmakers return from a monthlong recess.

However, the vast bipartisan support for the bill could help hasten its approval process. The legislation not only has more than 300 co-sponsors but sailed through the committee via a unanimous vote. 

The legislation also garners key support across both the payer and provider industries.

The Better Medicare Alliance, an advocacy group that includes insurers among its membership, urged passage of the bill which “offers a commonsense, bipartisan solution to further strengthen this valuable coverage option for our nation’s seniors,” said Mary Beth Donahue, president and CEO of the group.

The Medical Group Management Association also believes creating an electronic prior authorization program for MA will lessen the administrative burden on medical groups.

In addition, the American Medical Association (AMA) said that it is hoping for federal relief on this issue that has been prevalent across the healthcare industry. 

“For years, the American Medical Association sounded the alarm about burdensome prior authorization processes and their negative impact on patient outcomes,” said AMA President Jack Resneck Jr. in a statement. “Too often, prior authorization has resulted in delayed, denied or abandoned care.”