In the News

More than 230 House members and 61 senators are urging the Centers for Medicare & Medicaid Services to make changes to a rule the agency proposed in December to require health insurance companies to modernize the way they process requests from providers to authorize treatments.

Led by Rep. Suzan DelBene (D-Wash.), the bipartisan group of lawmakers wrote to the agency in a letter first reported by POLITICO. It calls on the agency to include provisions from DelBene’s Improving Seniors’ Timely Access to Care Act, which aims to speed up the prior authorization process for Medicare Advantage plans.

Those plans are managed by private insurers and serve about half of the Medicare population.

“The proposed CMS rules make huge strides forward for seniors,” DelBene told POLITICO. “But we think it needs to go further.”

“Modernizing and streamlining the prior authorization process is critical,” added South Dakota's John Thune, who's the No. 2 Republican in the Senate and helped organize the letter.

The lawmakers are calling on CMS to add several provisions to the regulation to align it more with the legislation, including:

— Real-time prior authorization for routine matters

— A 24-hour deadline for Medicare Advantage plans to answer prior authorization requests for “urgently needed care”

— More detailed transparency metrics

Click here to read the full article on Politico.