News Briefs: Lawmakers Take Another Stab at Improving Prior Authorization in MA

Jun 20
Jun 20, 2024

After the Improving Seniors’ Timely Access to Care Act unanimously passed in the House of Representatives last year but failed to make it through the Senate, leadership from both chambers have reintroduced the bill. The legislation, which aims to streamline the prior authorization process in Medicare Advantage, was reintroduced on June 12 by U.S. Senators Roger Marshall, M.D., (R-Kan.), Kyrsten Sinema (I-Ariz.), John Thune (R-S.D.), Sherrod Brown (D-Ohio), and U.S. Reps. Mike Kelly (R-Pa.), Suzan DelBene (D-Wash.), Larry Bucshon, M.D. (R-Ind.) and Ami Bera, M.D. (D-Calif.). The bill would, among other things, establish an electronic prior authorization process for MA plans including a standard process for transactions and clinical attachments; increase transparency around MA prior authorization requirements and its use; and clarify CMS’s authority to establish timeframes for e-PA requests including expedited determinations and real-time decisions for routinely approved items and services. It would also codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes rule that was finalized by CMS in January, according to the Regulatory Relief Coalition (RRC), which has been advocating for the so-called Seniors’ Act since it was first introduced in 2019. RRC, the American Medical Association, the American Hospital Association, and hundreds of other groups are urging passage of the legislation. Read more
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Lauren Flynn Kelly

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.