House Passes Prior Authorization Reform for Medicare Advantage Plans

Lawmakers call bill a ‘bipartisan success story’

September 14, 2022

The U.S. House today passed legislation to streamline the prior authorization process for Medicare Advantage (MA) plans and remove administrative barriers that delay care for older adults.

Lawmakers approved the Improving Seniors' Timely Access to Care Act of 2022. The bipartisan bill now moves to the Senate for consideration. The legislation has the support of more than 500 endorsing organizations—including HAP, the American Hospital Association, and the Better Medicare Alliance, a trade group representing MA plans.

Prior authorization is the process insurers use to determine if a service or treatment is medically necessary. The legislation is part of a broader focus on improving and modernizing prior authorization to ensure patients don’t have to wait to receive the care they need and deserve.

U.S. Representative Mike Kelly (R-16) is a lead sponsor of the original House legislation—H.R. 3173—and said the bill was a critical step forward to ensure older adults have timely access to care.

“That’s why we are here today: to move the prior authorization process into the 21^st century and give doctors and health insurance plans the tools they need to make these decisions more quickly,” Kelly said this afternoon.

The Improving Seniors' Timely Access to Care Act would:

• Establish an electronic prior authorization program and requirements for MA plans
• Create a list of items and services eligible for real-time decisions through the MA electronic prior authorization program
• Streamline and standardize the approval process for routine services
• Ensure requests are reviewed by qualified medical personnel
• Address potential disruptions in care as patients transition between MA plans

HAP continues to advocate for legislation at the state and federal levels to remove administrative barriers that delay patient access to care and services. For more information, contact Jolene Calla, Esq., HAP’s vice president, health care finance and insurance; or John Myers, HAP’s vice president, federal advocacy.