Bipartisan, Bicameral Prior Authorization Legislation Reintroduced

July 11, 2024 – Members of Congress have recently reintroduced bipartisan, bicameral legislation aimed at simplifying prior authorization (PA) within the Medicare Advantage (MA) program.

The Improving Seniors’ Timely Access to Care Act (S.4532/H.R 8702) is sponsored by Senators Roger Marshall, MD (R-Kan.), Krysten Sinema (I-Ariz.), John Thune (R-S.D.), and Sherrod Brown (D-Ohio), and Representatives Mike Kelly (R-Pa.), Suzan DelBene (D-Wash.), Larry Bucshon, MD (R-Ind.), and Ami Bera, MD (D-Calif.).

HRS and nearly 400 national and state organizations endorsed this legislation upon introduction. The legislation builds upon regulatory changes made by CMS effective January 1, 2024, which incorporated provisions from a prior version of the bill that unanimously passed the House of Representatives last Congress but did not advance in the Senate after receiving a sizeable cost estimate.

The current bill codifies the regulatory changes and would establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments; an increase in transparency around MA prior authorization requirements and use; clarification of CMS’ authority to establish timeframes for  electronic PA (e-PA) requests, including expedited determinations; real-time decisions for routinely approved items and services and other PA requests; an expansion of beneficiary protections to improve enrollee experiences and outcomes; and a requirement that the U.S. Department of Health and Human Services and other agencies report to Congress on program integrity efforts and other ways to further improve the e-PA process.

The bill sponsors worked to ensure that the additional provisions add minimal or no cost in the hope of securing passage before the end of the year.