Medicare Advantage Prior Authorization Bill Passed by House of Representatives

Medicare Advantage carriers will be subject to new requirements governing the prior authorization process under legislation passed by the House of Representatives on Wednesday.

The measure will require Medicare Advantage insurers to use electronic pre-authorization programs, submit annual lists of items and services subject to prior authorization, and adopt beneficiary protection standards. A bill to improve older people’s timely access to care is now heading to the Senate, where supporters hope it will move after November’s congressional elections.

This year’s Medicare Advantage pre-approval has come under fire. According to a report from the Department of Health and Human Services released in April, approximately 13% of denied prior authorization requests during the one-week period in June 2019 met Medicare fee-for-service coverage rules. Hospitals called on the Department of Justice to use the False Claims Act against Medicare Advantage insurers who wrongfully deny coverage.

The legislation, first introduced in 2019, is a rare bipartisan healthcare initiative that boasts more than 300 co-sponsors in the House of Representatives and support from both providers and insurance groups.

After the vote, lawmakers who pushed the measure through the House of Representatives called on the Senate and President Joe Biden to bring it into law.

“Older people and their families should be focused on getting the care they need, rather than repeatedly faxing forms for procedures that are usually approved. This takes precious time for healthcare providers, who spend an average of 13 hours a week on administrative work with preclearance-related documents.” — Representatives Susan DelBen (Washington), Ami Bera (D-Calif.), Larry Bakshon (Rp. state of Indiana). .) and Mike Kelly (Republican, PA) said in a joint press release.

Lawyers are optimistic about the bill’s chances in the Senate.

“We are encouraged by conversations with supporters and bill leaders in the Senate that legislation could be included in a comprehensive year-end package,” said Peggy Tai, a health lobbyist and legislative adviser to the Regulatory Assistance Coalition, an umbrella group that which includes physicians. organizations.

Senator Roger Marshall (R-Kansas), who co-sponsored the bill, said the bill is planned to be included in the mental health package being considered by the Senate Finance Committee. The committee did not respond to a request for comment.

“For almost four years, my colleagues and I have been working tirelessly on this bipartisan, bicameral legislation to modernize Medicare Advantage to better serve older adults in America,” Marshall said in a statement ahead of the House vote. “An important step forward has been made this week, but our work is not yet complete. I urge Senate leadership to work with me to bring the Older Adults’ Timely Access to Care Improvement Act to the President’s desk.”

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