Bipartisan Bill Aims to Streamline Prior Authorization, Improve Seniors’ Access to Care, and Reduce Administrative Burden for Healthcare Providers

By Trish Svoboda

The Improving Seniors’ Timely Access to Care Act has been reintroduced by a group of U.S. Senators and Representatives, including Sen. Roger Marshall, M.D. This bipartisan and bicameral legislation aims to simplify the prior authorization process under Medicare Advantage (MA). The goal is to enable seniors to receive the care they require and to assist healthcare providers in prioritizing patients over paperwork.

Prior authorization, a tool used by health plans to minimize unnecessary care, requires healthcare providers to obtain pre-approval for medical services. However, the system often leads to unverified faxes of patient information or clinician phone calls, which detract from the delivery of quality, timely care. It is the top administrative burden for healthcare providers, and it causes unnecessary delays for three out of four MA enrollees. The U.S. Department of Health and Human Services’ Office of the Inspector General has raised concerns after an audit found that MA plans approved 75% of initially denied requests. A recent report revealed that these plans wrongly denied beneficiaries’ access to services that met Medicare coverage rules.

“Prior authorization is the number one administrative burden facing physicians today across all specialties, Senator Marshall (R-KS) said. “As a physician, I understand the frustration this arbitrary process is causing health care practices across the country and the headaches it creates for our nurses. With the bipartisan, bicameral, Improving Seniors’ Timely Access to Care Act, we will streamline prior authorization and help improve patient outcomes and access to quality care and life-saving medicine. With the improvements we’ve made there is no reason we should not quickly get this bill signed into law.”

More than 370 organizations at both the national and state levels have expressed their support for this bill. These organizations represent patients, physicians, MA plans, hospitals, and other stakeholders in the healthcare industry.

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