Legislation to Modernize Seniors' Health Care Secures Support from Bipartisan Majority of House
A bipartisan majority of the U.S. House of Representatives now supports the Improving Seniors’ Timely Access to Care Act of 2019 (H.R. 3107), introduced by Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Roger Marshall, M.D. (KS-01), and Ami Bera, M.D. (CA-07). The bill would streamline and standardize prior authorization in Medicare Advantage (MA) and make the use of prior authorization more transparent. 219 members of Congress are now cosponsors of the legislation.
“Clinicians and medical staff should be spending their time with patients, not faxing back and forth with insurance companies over procedures that are routinely approved. We are pleased to see a bipartisan majority of the House now agrees. The changes included in the Improving Seniors’ Timely Access to Care Act of 2019 will provide much-needed relief for providers and this bill is evidence that there is still a place for bipartisanship in Washington,” said Reps. DelBene, Kelly, Marshall, and Bera.
Prior authorization is a tool used by insurers to prevent improper payments and reduce unnecessary care by requiring physicians and other health care professionals to get pre-approval for certain medical services. However, it’s not without fault. Each plan has a unique way of handling prior authorization, often requiring the faxing of a patient’s medical information or phone calls by clinicians, which takes precious time away from patient care and can potentially lead to a delay of needed medical intervention. In 2018, the U.S. Department of Health & Human Services’ Office of the Inspector General raised concerns after an audit revealed that MA plans ultimately approved 75% of requests that were originally denied.
Health plans and providers agree that the process can be improved and agreed on principles in a 2018 consensus statement. Building on these principles, the bill would improve the prior authorization process in MA plans by moving the process to an electronic standard as well as introduce automation efforts that will lead to real-time decision making. It would also ensure health care providers know exactly what information they need to submit to insurance plans when requesting prior authorization, reducing the time and effort spent corresponding and gaining an understanding of how the plans are making these decisions.
The policies of this bill will allow health care providers to focus on delivering quality patient care. Recognizing the importance of this issue, this legislation has gained support by over 400 organizations across the country.
“The Arthritis Foundation strongly supports H.R. 3107 because this bipartisan legislation would make necessary patient-centered reforms,” said Ann Palmer, President and CEO, Arthritis Foundation. “Our surveys consistently tell us that prior authorization is a top concern for people with arthritis and their families. We are pleased to see the bill reach this impressive milestone in the legislative process and look forward to its passage into law.”
“Neurosurgeons take care of very sick patients who suffer from painful and life-threatening neurologic conditions such as brain tumors, debilitating, degenerative spine disorders and stroke, and without timely medical care, our patients often face permanent neurologic damage, and sometimes death. Streamlining prior authorization will help ensure that our seniors get the care they need without delay, and we are thrilled that a bipartisan majority of the House of Representatives now supports H.R. 3107,” said Ann R. Stroink, M.D., on behalf of the American Association of Neurological Surgeons and Congress of Neurological Surgeons.
The full text of this bill can be found here.