The Improving Seniors’ Timely Access to Care Act would streamline the prior authorization process under Medicare Advantage (MA) plans to allow older Americans to get the care they need faster.
The legislation would help health care providers prioritize patients over paperwork.
U.S. Sen. Tim Kaine of Virginia, a member of the Senate Health, Education, Labor and Pensions (HELP) Committee, joined a bipartisan, bicameral group of colleagues in reintroducing the legislation.
Prior authorization is a leading cause of administrative burden as identified by health care providers. Prior authorization is a tool used by health plans that requires providers to get pre-approval for medical services, which can result in lapses of communication between clinicians and insurance companies and longer wait times for patients. The legislation would streamline prior authorization processes for patients on MA plans to ensure patients can access medical services in a timely manner.
“Older Americans shouldn’t be forced to wait to get critical care because their providers are busy dealing with a mountain of paperwork,” Kaine said. “This bipartisan legislation would streamline health care processes to ensure that Americans covered by Medicare Advantage can access the care they need more quickly and enable doctors and health care providers to direct more of their time to their patients.”
The Improving Seniors’ Timely Access to Care Act would enable health care professionals to better serve patients and reduce unnecessary administrative burdens.
The legislation would:
- Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments.
- Increase transparency around MA prior authorization requirements and its use.
- Clarify the Centers for Medicare and Medicaid Services’ authority to establish timeframes for electronic prior authorization requests including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
- Expand beneficiary protections to improve enrollee experiences and outcomes.
- Require the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to further improve the electronic prior authorization process.
Across Virginia and the nation, health care professionals are experiencing an increase in burnout following the COVID-19 pandemic, and high administrative burdens are a direct contributing factor, according to the 2022 U.S. Surgeon General report. Kaine has introduced multiple bills to address burnout among health care professionals and increase access to mental health resources, including the Dr. Lorna Breen Health Care Provider Protection Act, which was signed into law to expand mental health services for health care workers to prevent suicide, burnout and mental health conditions. Last month, Kaine spearheaded the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act to extend those resources.
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Rebecca Barnabi
