What’s the news: The House Ways and Means Committee successfully drafted and passed legislation that would streamline the pre-authorization processes in Medicare Advantage plans.
The most significant legislative milestone for “The Improving Senior’s Timely Access to Care Act of 2022” — which has broad bipartisan support — came through a bipartisan agreement between the Ways and Means committee chair, Richard Neal, a Democrat from Massachusetts, and the The committee’s highest-ranking member, Texas Republican Kevin Brady.
Two other members of the Ways and Means Committee, Rep. Suzan DelBene, D-Wash., and Mike Kelly, R-Pa., have long been advocates of pre-authorization reform and played a key role in formulating the underlying legislation and pushing Neal and Brady to hold the hearing. .
Recovering prior clearance is an essential part of the AMA Recovery Plan for America’s Physicians. You took care of the nation. It’s time for the nation to take care of you. It’s time to rebuild. And the AMA is done.
Pre-authorization is overused and existing processes present significant administrative and clinical problems. Learn how the AMA handles pre-approval with research, practice, and reform resources.
Why it’s important: “For years, the American Medical Association has sounded the alarm about difficult pre-authorization processes and their negative impact on patient outcomes. Too often, prior authorization has resulted in delayed, refused, or abandoned care,” said AMA president Jack Resneck Jr., MD.
AMA survey data (PDF) shows that “more than a third (34%) of physicians reported that prior consent resulted in a serious adverse event, such as hospitalization, disability, or even death, for a patient in their care,” says Dr. . Resneck added.
The House’s original law, HR 3173, which also has an accompanying bill in the Senate, reduces unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program. This particular bill, which has more than 340 bipartisan co-sponsors in the House and Senate, contains all the key elements of a 2018 consensus statement developed by leading physicians, hospitals, medical groups, health plans and pharmacy stakeholders.
The House Ways and Means Committee eventually introduced, flagged and passed a new, amended prior consent reform bill, HR 8487, “The Improving Seniors Timely Access to Care Act of 2022,” to introduce a variety of technical changes to to grab.
Specifically, the bill would:
- Requires Medicare Advantage plans to implement electronic pre-authorization programs that meet newly developed federal standards, and to establish real-time decision-making processes for items and services identified as “routinely approved.”
- Mandate that Medicare Advantage plans provide accelerated pre-authorization decisions for all other services in Medicare Part C.
- Improve transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services on the extent of their use of pre-authorization and the percentage of approvals and denials.
On a recent episode of “AMA Moving Medicine,” Representative DelBene spoke about her own family’s experience with prior consent.
Learn more: This week also marked bipartisan support in the House for a bill that extends Medicare telecare payment and regulatory flexibility through the end of 2024. The House approved measure 416-12.
“The public health emergency due to COVID-19 has made it clear that telehealth care must be available to all Medicare patients, especially their own doctors, regardless of where they live or how they access these services,” he said. dr. Resneck in response to the vote. . “From continuity of care, expanded access to care, and the removal of geographic and origin restrictions, we hope that the flexibility offered during the public health emergency will be made permanent.”
The AMA is urging the Senate to act on this bipartisan bill, and for Congress to build on this success, added Dr. Resneck to it.
Telehealth support is another vital part of the AMA Recovery Plan for America’s Physicians. Telehealth is critical to the future of healthcare, which is why the AMA continues to lead the way in aggressively expanding telehealth policies, research and resources to ensure the sustainability of physician practice and fair pay .