On Wednesday, a bipartisan bill to reduce the administrative burdens of prior authorization (PA) in the Medicare Advantage (MA) program was introduced in the House by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall (R-KS), and Ami Bera (D-CA). ASCRS and the Alliance of Specialty Medicine oppose the use of PA and step therapy in MA plans and issued support for the legislation upon introduction.
The legislation, titled ‘‘Improving Seniors’ Timely Access to Care Act of 2019,’’ would establish requirements for use of PA in MA plans. The bill includes the following provisions, among others:
- Establishes an electronic prior authorization process
- Prohibits MA plans from requiring PA on any surgical or other invasive procedure if the procedure is furnished during the perioperative period
- Requires the HHS Secretary to establish a process for “real-time decisions” for routine non-complex items and services for which PA requests are routinely approved
- Implements certain transparency requirements that must be met by MA plans
We will keep you updated.