House Passes Sen. Marshall’s Bill to Improve Care for 28M Seniors

Bipartisan legislation would modernize prior authorization process to make it easier for seniors to get the care they need 

(Washington, D.C., September 14, 2022) – Today, U.S. Senator Roger Marshall, M.D.’s Improving Seniors’ Timely Access to Care Act passed the U.S. House of Representatives. This bipartisan legislation would improve timely access to quality care for seniors under Medicare Advantage. Specifically, the bill would modernize the way Medicare Advantage plans and health care providers use prior authorization. This legislation addresses the number one administrative issue for physicians today, and will make the delivery of health care more patient and doctor friendly. Since its introduction, over 500 organizations that represent patients, physicians, hospitals, and other key stakeholders in the health care industry have officially endorsed the legislation.

“For nearly four years, my colleagues and I have worked tirelessly on this bipartisan, bicameral legislation to modernize Medicare Advantage to better serve America’s seniors,” said Senator Marshall. “This is the most supported health care bill in the entire Congress both in the number of cosponsors and the weight of more than 500 national and state endorsing organizations. The support underscores our legislation’s significance to patients, health care providers, and innovators in medicine. Today marks an important step forward, but our work is not finished. I urge Senate leadership to work with me in moving the Improving Seniors’ Timely Access to Care Act to the President’s desk.”

Senators Kyrsten Sinema (D-AZ), John Thune (R-SD), and Sherrod Brown (D-OH) joined Senator Marshall in introducing the bill. The legislation is led in the House by Representatives Suzan DelBene (WA-01), Mike Kelly (PA-16), Ami Bera, M.D. (CA-07), and Larry Bucshon, M.D. (IN-08). It has over 320 cosponsors.

“Seniors and their families should be focused on getting the care they need, not faxing forms multiple times for procedures that are routinely approved. This takes away valuable time from providers who on average spend 13 hours a week on administrative paperwork related to prior authorization,” said DelBene, Kelly, Bera, and Buschon. “The Improving Seniors’ Timely Access to Care Act will make it easier for seniors to get the care they need by cutting unnecessary red tape in the health care system. We urge the Senate to quickly take up this legislation and get it to President Biden’s desk.”

Background:

Prior authorization is a tool used by health plans to reduce spending from improper payments and unnecessary care by requiring physicians and other health care providers to get pre-approval for medical services. But it’s not without fault. The current system of unconfirmed faxes of a patient’s medical information or phone calls by clinicians takes precious time away from delivering quality and timely care. Prior authorization continues to be the #1 administrative burden identified by health care providers and nearly four out of five Medicare Advantage enrollees are subject to unnecessary delays. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.

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. Building on these principles, the bipartisan legislation would:

• establish an electronic prior authorization process that would streamline approvals and denials;
• establish national standards for clinical documents that would reduce administrative burdens for health care providers and Medicare Advantage plans;
• create a process for real-time decisions for certain items and services that are routinely approved;
• increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients;
• ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines; and
• require beneficiary protections that would ensure the electronic prior authorization serves seniors first.

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