In an attempt to standardize and streamline the prior authorization process for patients with Medicare Advantage plans, a bipartisan, bicameral group of Congressional colleagues has reintroduced the Improving Seniors’ Timely Access to Care Act.
The bill is designed to reduce paperwork barriers that stand between American seniors and the care their doctors prescribe. It specifically applies to items and services – and excludes medications – but it’s a crucial first step toward broader system improvement.
Providers Are Buried in Paperwork While Patients Wait for Care
For the 28 million older Americans enrolled in Medicare Advantage plans, prior authorization requirements interfere with prompt treatment and access to critical care services.
Such authorizations are designed to control costs for insurers, but physicians point out that navigating the process is excessively time consuming on their end. And one-third of doctors report a patient in their care has suffered a life-threatening medical event while waiting for insurance approval.
Prior authorization and use of AI within Medicare Advantage have stymied some seniors’ care, amounting to what House lawmakers criticized as “widespread and persistent problems related to denials of care.”
Medicare Advantage Ripe for Reform
Medicare handles the required pre-approvals through a series of paper forms, an outdated approach that is resource intensive.
Surveys indicate prior authorization paperwork is a key contributor to rising trends of administrative strain and provider burnout. Streamlining the process using a standardized digital system could save billions in health care resources, and promote better patient care all while reducing administrative burden.
In addition to process improvements, the Improving Seniors’ Timely Access to Care Act would also require the following for items and services:
- Plans must respond to requests and appeals promptly
- Transparency reporting for prior authorization uses
- Expanded patient protections that could spur better patient experiences and improved outcomes.
The bill received unanimous support in the House during the 2023 session, and its reintroduction in Congress is giving patients and providers hope that helpful change might soon be underway.
