Many APTA members continue to face significant challenges with Medicare Advantage plans. Medically necessary physical therapy services are too often delayed due to excessive administrative burdens and outdated prior authorization processes, jeopardizing patient outcomes and placing undue strain on providers. Additionally, physical therapists frequently receive inadequate reimbursement for care provided to Medicare Advantage enrollees.
We’re calling on Congress to take action.
The Improving Seniors’ Timely Access to Care Act (H.R. 3514/S. 1816) would address prior authorization by:
- Requiring Medicare Advantage plans to adopt electronic prior authorization systems,
- Mandating real-time decisions for routinely approved services, and
- Requiring plans to report their use of prior authorization to CMS to increase transparency and accountability.
The Prompt and Fair Pay Act (H.R. 4559) would ensure timely and fair reimbursement by:
- Establish a payment floor requiring Medicare Advantage plans to reimburse for all covered health care items and services at least at what would have been paid under Medicare Parts A and B. Plans and providers may continue to negotiate higher reimbursement rates.
- Require prompt payment for clean in-network claims.
Your voice makes a difference.
Please contact your members of Congress and urge them to cosponsor both of these crucial bills. Taking just a few minutes today can help reduce administrative burdens, improve patient access to care, and ensure fair payment for the services you provide.
Thank you for being a vital part of APTA’s advocacy efforts.