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Prior authorization (PA) requirements are put in place by Medicare Advantage (MA) plans to help ensure high-quality, cost-effective care while preventing unnecessary utilization.
In reality, the current prior authorization system imposes excessive administrative burdens on medical practices through complex requirements and electronic health record maintenance, reducing physicians' time with patients and increasing operational costs. It also regularly delays or completely prevents patients from receiving necessary care and negatively interferes with the all-important doctor-patient relationship.
The Improving Seniors' Timely Access to Care Act
The Improving Seniors' Timely Access to Care Act would prioritize patient care over paperwork by modernizing and streamlining the prior authorization process in Medicare Advantage. This legislation would mandate electronic prior authorization for MA plans, standardize transactions and clinical documentation requirements, and increase transparency around MA prior authorization practices. Additionally, it would empower CMS to establish clear timeframes for prior authorization decisions and require regular congressional reporting on program integrity efforts from HHS and other agencies.
In the 118th Congress, the Seniors’ Act received bipartisan cosponsorship from 232 Representatives and 60 Senators.
What Congress should do:
On July 21, the House Energy and Commerce Committee voted unanimously to advance the AAOS-endorsed Improving Seniors’ Timely Access to Care Act (H.R. 3514), setting the stage for a full vote in the House later this year.