Bi-partisan legislation was recently introduced in the House of Representatives aimed at protecting patients from the burden of prior authorizations. The Improving Seniors’ Timely Access to Care Act of 2019 (H.R. 3107) would reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors.
Specifically, the bill would:
- Create an electronic prior authorization program including the electronic transmission of prior authorization requests and responses and a real-time process for items and services that are routinely approved;
- Improve transparency by requiring plans to report to Centers for Medicare & Medicaid Services on the extent of their use of prior authorization and the rate of approvals or denials;
- Require plans to adopt transparent prior authorization programs that are reviewed annually, adhere to evidence-based medical guidelines, and include continuity of care for individuals transitioning between coverage policies to minimize any disruption in care;
- Hold plans accountable for making timely prior authorization determinations and providing rationales for denials; and
- Prohibit additional prior authorization for medically necessary services performed during a surgical or invasive procedure that already received, or did not initially require, prior authorization.
The demand and need for such reforms is growing — particularly as more seniors choose Medicare Advantage for their health insurance needs. For far too long, insurance companies have hid behind prior authorization requirements in order to cut costs and boost their bottom line, all at the expense of the patient. Hopefully, that is about to change. This bill takes meaningful steps to curb insurers’ abuse of prior authorization requirements in order to save money, as well as protects patients from care disruptions.
Use this form to contact your Representative and ask them to support the Improving Seniors’ Timely Access to Care Act of 2019 today!