House passes bill to install electronic prior authorization in Medicare Advantage plans

The House passed key legislation that creates an electronic prior authorization process for Medicare Advantage (MA) plans and other reforms aimed at a major headache for providers. 

The House unanimously passed the Improving Seniors’ Timely Access to Care Act on Wednesday via a voice vote. The legislation, which has new transparency requirements for MA plans, now heads to the Senate.

Lawmakers behind the legislation said in a joint statement the bill will “make it easier for seniors to get the care they need by cutting unnecessary red tape in the healthcare system,” said Reps. Suzan DelBene, D-Washington, Mike Kelly, R-Pennsylvania, Ami Bera, M.D., D-California, and Larry Bucshon, M.D., R-Indiana.

Prior authorization—where providers must first get insurer approval before performing certain services or making prescriptions—has increased in recent years much to the chagrin of providers who charge the process causes a massive administrative burden.

The House bill aims to require the establishment of an electronic prior authorization process for all MA plans to hasten the approval of requests. It would also require the Department of Health and Human Services (HHS) to create a process for faster, “real-time” decisions on the items or services that already get routinely approved.

Another new requirement is that MA plans must report to the federal government on how they use prior authorization, as well as the rate that such requests are approved and denied. The requirement comes as HHS’ watchdog found that MA plans have denied prior authorization claims for services that met Medicare’s coverage requirements.

The overwhelming House vote earned plaudits from several provider groups. 

“At a time when group practices face unprecedented workforce shortage challenges, 89% of [Medical Group Management Association] members report they do not have adequate staff to process the increasing number of prior authorizations from health insurers,” the Medical Group Management Association said in a statement. “By streamlining and standardizing the overly cumbersome and wildly inefficient MA prior authorization process, this legislation will return a focus to the physician-patient relationship.”