WASHINGTON – U.S. Senators Bill Cassidy, M.D. (R-LA) and Roger Marshall (R-KS) introduced the Improving Seniors’ Timely Access to Care Act to improve access to care for seniors enrolled in Medicare Advantage (MA) plans by streamlining the time-consuming prior authorization process. The bill would ultimately allow healthcare providers to spend more time on patient care rather than administrative burdens.
“Prior authorization places more importance on process than patients. As a doctor, I want that to change. Let’s make sure seniors are receiving timely care,” said Dr. Cassidy.
“Prior authorization is the number one administrative burden facing physicians today across all specialties,” said Senator Marshall. “As a physician, I understand the frustration this arbitrary process is causing health care practices across the country and the headaches it creates for our nurses. With the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, we will streamline prior authorization and help improve patient outcomes and access to quality care.”
Cassidy and Marshall were joined by U.S. Senators Shelley Moore Capito (R-WV), Mark Warner (D-VA), Maggie Hassan (D-NH), James Lankford (R-OK), John Fetterman (D-PA), Marsha Blackburn (R-TN), Amy Klobuchar (D-MN), Cynthia Lummis (R-WY), John Hickenlooper (D-CO), Cindy Hyde-Smith (R-MS), Jeff Merkley (D-OR), John Boozman (R-AR), Tim Kaine (D-VA), Mike Rounds (R-SD), Bill Hagerty (R-TN), Jeanne Shaheen (D-NH), John Cornyn (R-TX), Alex Padilla (D-CA), Thom Tillis (R-NC), Andy Kim (D-NJ), Jerry Moran (R-KS), Dick Durbin (D-IL), Ted Budd (R-NC), Patty Murray (D-WA), Tim Sheehy (R-MT), Kirsten Gillibrand (D-NY), Pete Ricketts (R-NE), Maria Cantwell (D-WA), John Hoeven (R-ND), Mazie Hirono (D-HI), Rick Scott (R-FL), Cory Booker (D-NJ), Deb Fischer (R-NE), Tina Smith (D-MN), Peter Welch (D-VT), Sheldon Whitehouse (D-RI), Catherine Cortez Masto (D-NV), Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Elizabeth Warren (D-MA), Tammy Duckworth (D-IL), Mark Kelly (D-AZ), Jacky Rosen (D-NV), Martin Heinrich (D-NM), and Chris Coons (D-DE).
“Too often, seniors have to wait to receive vital care because of administrative burdens like prior authorization. I’m proud to join my colleagues in introducing the Improving Seniors’ Timely Access to Care Act, which will streamline prior authorization and reduce unnecessary health care delays,” said Senator Capito.
“Seniors across the Cowboy State rely on Medicare, but too often, bureaucratic red tape gets in the way of timely care,” said Senator Lummis. “I am proud to join my colleagues across the aisle to streamline the prior authorization process and put patients over paperwork.”
“Excessive administrative burdens within the Medicare Advantage program means too many seniors receive delayed benefits, while our health care providers are overwhelmed by paperwork. The current system isn’t working well for anyone, and it’s time we take meaningful action to fix it. This commonsense legislation is a necessary step in the right direction,” said Senator Hyde-Smith.
“Quality, expedited medical care should always be within reach for seniors, and our providers deserve a system that helps them focus on delivering it,” said Senator Boozman. “I’m pleased to join this bipartisan effort to end the inefficient process that delays Medicare Advantage beneficiaries’ evaluations and treatments while removing an unnecessary, bureaucratic burden on clinicians.”
“Doctors and health care providers are too often bogged down by unnecessary burdens, which can lead to delayed care and negative outcomes for patients,” said Senator Cornyn. “By streamlining the prior authorization process under Medicare Advantage, this legislation would cut red tape, improve enrollee experiences, and ensure seniors receive the timely care they deserve.”
“Improving the prior authorization process will help seniors have quicker access to the health care they need and remove administrative hurdles for physicians,” said Senator Moran. “This legislation would make commonsense changes to better support thousands of seniors in Kansas and remove the red tape that is costing doctors and patients valuable time.”
“North Carolina seniors shouldn’t face unnecessary delays when trying to access the care they need through Medicare Advantage,” said Senator Tillis. “I’m proud to support this bipartisan, commonsense legislation that streamlines the prior authorization process, cuts red tape for providers, and ensures patients get timely access to treatment.”
U.S. Representatives John Joyce, M.D. (R-PA-13), Suzan DelBene (D-WA-01), Mike Kelly (R-PA-16), and Ami Bera, M.D. (D-CA-06) introduced companion legislation in the U.S. House of Representatives.
This legislation is supported by the Better Medicare Alliance, Humana, and 138 other health care organizations.
“Prior authorization helps keep health care costs low and ensures seniors are getting the most appropriate care. But the process should be easier. The changes put forth in this legislation are long overdue and will help ensure seniors can get the care they need without delay,” said Mary Beth Donahue, President and CEO of Better Medicare Alliance. “We are proud to support this bill and thank Senators Marshall and Warner, and Representatives Kelly, DelBene, Bera, and Joyce for their leadership. We look forward to continued work on this issue with Congress and the Administration.”
“Humana’s job is to ensure our members have access to high quality, affordable healthcare. We support efforts in the House and Senate to move the Seniors’ Timely Access to Care Act forward quickly,” said Jim Rechtin, Humana CEO. “It is a common-sense approach to making healthcare easier by modernizing the prior authorization process.”
The Improving Seniors’ Timely Access to Care Act would:
- Establish an electronic prior authorization process for Medicare Advantage plans, including a standardization for transactions and clinical attachments.
- Increase transparency around Medicare Advantage prior authorization requirements and their use.
- Clarify U.S. Department of Health and Human Services’ (HHS) authority to establish timeframes for e-prior authorization requests, including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
- Expand beneficiary protections to improve enrollee experiences and outcomes.
- Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-prior authorization process.
- Result in a zero cost to American taxpayers.
- Codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.
Background
Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. The current system often results in multiple faxes or phone calls by clinicians, which takes precious time away from delivering care. Prior authorization continues to be the number one administrative burden identified by health care providers, and nearly three out of four Medicare Advantage enrollees are subject to unnecessary delays due to the practice.
Last Congress, the bill was supported by a super majority of members in the U.S. Senate (60) and was unanimously passed by the U.S. House of Representatives in 2022.
In 2018, the HHS Office of the Inspector General raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.
In 2022, the HHS Office of Inspector General released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.
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