ICYMI: House Unanimously Passes NDC-Endorsed Bill to Improve Care for 28M Seniors, Cut Red Tape
Bipartisan legislation would modernize prior authorization process to make it easier for seniors to get the care they need
Today, the U.S. House of Representatives unanimously passed the Improving Seniors’ Timely Access to Care Act (H.R. 3173) by voice vote. The legislation would make it easier for seniors to get the care they need and improve health outcomes by modernizing the antiquated prior authorization process in Medicare Advantage, which often still requires faxing documents to insurance companies. Nationally, 28 million seniors are enrolled in Medicare Advantage, including over 600,000 in Washington state.
Many Medicare Advantage plans require providers to obtain prior authorization for certain medical procedures and tests before they can provide care to their patients. Prior authorization can play a role in ensuring people receive appropriate treatments and help control the cost of care. However, when misused, prior authorization can delay needed medical intervention and result in administrative burdens for providers.
The bill would:
- Establish an electronic prior authorization process.
- Require the U.S. Department of Health & Human Services (HHS) to establish a process for “real-time decisions” for items and services that are routinely approved.
- Improve transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services on the extent of their 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.
The legislation is led in the House by Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera, M.D. (CA-07), and Larry Bucshon, M.D. (IN-08). It has over 320 cosponsors and the endorsement of over 500 organizations.
“Seniors and their families should be focused on getting the care they need, not faxing forms multiple times for procedures that are routinely approved. This takes away valuable time from providers who on average spend 13 hours a week on administrative paperwork related to prior authorization,” said DelBene, Kelly, Bera, and Buschon. “The Improving Seniors’ Timely Access to Care Act will make it easier for seniors to get the care they need by cutting unnecessary red tape in the health care system. We urge the Senate to quickly take up this legislation and get it to President Biden’s desk.”
The bill now goes to the Senate, where it also has strong bipartisan support.
“For nearly four years, my colleagues and I have worked tirelessly on this bipartisan, bicameral legislation to modernize Medicare Advantage to better serve America’s seniors,” said Senator Marshall, the bill’s lead in the Senate. “This is the most supported health care bill in the entire Congress both in the number of cosponsors and the weight of more than 500 national and state endorsing organizations. The support underscores our legislation’s significance to patients, health care providers, and innovators in medicine. Today marks an important step forward, but our work is not finished. I urge Senate leadership to work with me in moving the Improving Seniors’ Timely Access to Care Act to the President’s desk.”
In July, the House Ways & Means Committee advanced the legislation without opposition.
A fact sheet on the Improving Seniors’ Timely Access to Care Act can be found here.
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