The Seniors’ Timely Access to Care Act, which is designed to address issues with Medicare Advantage plans’ use of prior authorization, has been reintroduced in Congress by a bipartisan group of legislators. The bill would establish an electronic standard to streamline approval of prior authorization requests by Medicare Advantage plans, reduce the amount of time required for MA plans to respond to prior authorization requests, require the plans to list the items and services subject to prior authorization requirements, and require them to report the number and rate of prior authorization approvals and denials.  The bill is supported by over 370 provider organizations. It passed the House of Representatives in 2022, but stalled in the Senate.

In June 12, 2024 letters sent to members of Congress, the American Hospital Association thanked them for supporting the bill and urged both houses of Congress to pass it.  The letters pointed out that “[i]nefficient prior authorization requirements are a pervasive problem among certain plans in the Medicare Advantage (MA) program that result in delays in care and add financial burden and strain to the health care system.”  The letters also stated that the “bipartisan legislation would address these issues….”

At its Annual Meeting in Chicago, the American Medical Association also addressed health insurer abuses of prior authorization. On June 11, 2024, the AMA House of Delegates adopted policies designed to address health insurers’ “onerous prior authorization requirements that are delaying and denying necessary care for patients and adding administrative burdens for physicians.”  The policies call for greater transparency and oversight of insurers’ use of prior authorization and for legal accountability when prior authorization policies conflict with patients’ interests.

In a statement, AMA Board Member Marilyn Heine, M.D. said: “Waiting on a health plan to authorize necessary medical treatment is too often a hazard to patient health. To protect patient-centered care, the AMA will work to support legal consequences for insurers that harm patients by imposing obstacles and burdens that interfere with medically necessary care.

The AHA’s letter to Senators is linked here and its letter to members of the House of Representatives is linked here. The AMA press release on its new policies is linked here.

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