Press Releases

Today, Representatives Suzan DelBene (WA-01) and Mike Kelly (PA-16) released a joint statement after the Improving Seniors' Timely Access to Care Act, their legislation to reform and modernize prior authorization for seniors on Medicare Advantage, unanimously passed the Ways & Means Committee.

The bill, which has a bipartisan supermajority of nearly 300 House co-sponsors, now advances to the full U.S. House of Representatives for consideration.

“We are incredibly pleased to see the Improving Seniors’ Timely Access to Care Act advance out of our committee and move to the full U.S. House of Representatives,” the members said. “This legislation puts patient care and patient outcomes first, and it will greatly modernize and streamline the prior authorization process. Today's vote moves this critical legislation one step closer to becoming law.”

Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. But it’s not without fault. The current system often results in unconfirmed faxes of a patient’s medical information or phone calls by clinicians, which takes precious time away from delivering quality and timely care.

Prior authorization continues to be the top administrative burden identified by health care providers, and three out of four Medicare Advantage enrollees are subject to unnecessary delays due to prior authorization. In recent years, the Office of the Inspector General at the Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75%of requests that were originally denied. More recently, HHS released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization.

More than 35 million American seniors, including nearly 800,000 Washingtonians, are enrolled in Medicare Advantage.

The bill would:

• Establish an electronic prior authorization process for MA plans including standardization for transactions and clinical attachments.

• Increase transparency around MA prior authorization requirements and its use.

• Clarify HHS’ authority to establish timeframes for e-prior authorization requests including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.

• Expand beneficiary protections to improve enrollee experiences and outcomes.

• Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.

DelBene led similar legislation in the 118th Congress. The Improving Seniors’ Timely Access to Care Act unanimously passed the House in the 117th Congress and was cosponsored by a majority of members in the Senate and House of Representatives.

The bill text can be found here and a section-by-section can be found here.