Bipartisan legislation is pending in Congress that would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes rule that was finalized by the Centers for Medicare & Medicaid Services on Jan. 17, 2024. 

This ACOI-endorsed legislation makes the Medicare Advantage (MA) prior authorization process transparent and more efficient to improve timely access to medically necessary care for our nation’s seniors and to reduce administrative burdens on health care providers who serve them. 

Specifically, the Improving Seniors’ Timely Access to Care Act (H.R. 3514 / S. 1816) would:

• Establish an electronic prior authorization process for MA plans, including a standardization for transactions and clinical attachments.
•  Increase transparency around MA prior authorization requirements and their use.
• Provide a pathway for CMS to institute real-time decisions for routinely approved items and services in the future and clarify CMS’ authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services and any other PA request.
• Expand beneficiary protections to improve enrollee experiences and outcomes.
• Require the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to improve the e-PA process.

Lawmakers need to hear from you, their constituents, about why the Improving Seniors’ Timely Access to Care Act needs to be passed this year. Take a moment to email your members of Congress and ask them to cosponsor the bill.