TYLER – U.S. Senator John Cornyn (R-TX) joined Sens. Roger Marshall, M.D. (R-KS), Mark Warner (D-VA), and 44 of his Senate colleagues in introducing the Improving Seniors’ Timely Access to Care Act, which would improve access to care for seniors enrolled in Medicare Advantage (MA) plans at no cost to American taxpayers. The legislation focuses on streamlining the often cumbersome and time-consuming prior authorization process, ultimately allowing healthcare providers to spend more time on patient care rather than administrative burdens.

“Doctors and health care providers are too often bogged down by unnecessary burdens, which can lead to delayed care and negative outcomes for patients,” said Sen. Cornyn. “By streamlining the prior authorization process under Medicare Advantage, this legislation would cut red tape, improve enrollee experiences, and ensure seniors receive the timely care they deserve.”

Additional cosponsors include U.S. Senators Maggie Hassan (D-NH), John Fetterman (D-PA), Amy Klobuchar (D-MN), Bill Cassidy (R-LA),  Shelley Moore Capito (R-WV), John Hickenlooper (D-CO), James Lankford (R-OK), Jeff Merkley (D-OR), Marsha Blackburn (R-TN), Cynthia Lummis (R-WY), Cindy Hyde-Smith (R-MS), Tim Kaine (D-VA), Jeanne Shaheen (D-NH), Mike Rounds (R-SD), Alex Padilla (D-CA), Bill Hagerty (R-TN), Andy Kim (D-NJ), John Boozman (R-AR), Dick Durbin (D-IL), Patty Murray (D-WA), Jerry Moran (R-KS), Kirsten Gillibrand (D-NY), Maria Cantwell (D-WA), Mazie Hirono (D-HI), Thom Tillis (R-NC), Cory Booker (D-NJ), Tina Smith (D-MN), Peter Welch (D-VT), Sheldon Whitehouse (D-RI), Ted Budd (R-NC), Catherine Cortez Masto (D-NV), Tim Sheehy (R-MT), Tammy Baldwin (D-WI), Pete Ricketts (R-NE), Richard Blumenthal (D-CT), Elizabeth Warren (D-MA), Tammy Duckworth (D-IL), John Hoeven (R-ND), Rick Scott (R-FL), Mark Kelly (D-AZ), Jacky Rosen (D-NV), Martin Heinrich (D-NM), Deb Fischer (R-NE) and Chris Coons (D-DE).

Background:

Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. However, the current system often results in multiple faxes or phone calls by clinicians, which takes precious time away from delivering care. Prior authorization continues to be the number-one administrative burden identified by health care providers, and nearly three out of four Medicare Advantage enrollees are subject to unnecessary delays due to the practice.

The Improving Seniors’ Timely Access to Care Act would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.

Last Congress, the bill was supported by a super majority of members in the Senate (60) and a majority in the House (232), and was unanimously passed by the House in 2022. In 2018, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied. In 2022, the HHS Office of Inspector General released a report finding that MA plans incorrectly denied beneficiaries’ access to services even though they met Medicare coverage rules.

The Improving Seniors’ Timely Access to Care Act would:

• Establish an electronic prior authorization process for Medicare Advantage plans, including a standardization for transactions and clinical attachments;
• Increase transparency around Medicare Advantage prior authorization requirements and their use;
• Clarify HHS’ authority to establish timeframes for e-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 HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-prior authorization process;
• And result in a zero cost to American taxpayers.

Full text of the legislation can be found here.