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Good News on Medicare Advantage Prior Authorization Bill

May 09, 2024

A bipartisan bill that would improve the prior authorization process for seniors on Medicare Advantage will be making a comeback in Congress.

This week, lawmakers in the Senate Budget Committee revealed the Congressional Budget Office’s (CBO) estimated cost to implement the “Improving Seniors’ Timely Access to Care Act” would be reduced from $16 billion down to zero.

Championed by Representative Mike Kelly (PA-16), the legislation passed the house during 2022, but faced scrutiny in the Senate following the CBO’s initial $16 billion estimate. A final rule from CMS earlier this year reduced the implementation costs, formalizing aspects within the rule.

“Increasing efficiency and enabling health care data to flow freely and securely between patients, providers, and payers and streamlining prior authorization processes supports better health outcomes and a better health care experience for all,” CMS Administrator Chiquita Brooks-LaSure said in a statement earlier this month.

The bill would:

  • Establish an electronic prior authorization process.
  • Require the U.S. Department of Health & Human Services to establish a process for “real-time decisions” for items and services that are routinely approved.
  • Require Medicare Advantage plans to report to CMS on the use of prior authorization and the rate of approvals or denials.
  • Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.

HAP has been a longtime advocate for the bill to improve access to care for seniors on Medicare Advantage, which serves 54 percent of Medicare beneficiaries.

HAP will provide updates to members as the legislation moves through Congress. For more information, contact John Myers, HAP’s vice president, federal advocacy.