Bipartisan legislation is pending in Congress that would codify and enhance elements of the Advancing  Interoperability and Improving Prior Authorization Processes rule that was finalized by the Centers for Medicare & Medicaid Services on Jan. 17, 2024. 

This ACOI-endorsed legislation makes the Medicare Advantage (MA) prior authorization process transparent and more efficient to improve timely access to medically necessary care for our nation’s seniors and to reduce administrative burdens on health care providers who serve them. 

Specifically, the Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532) would:

• Require MA plans that impose any PA requirements to establish an electronic PA program that provides for the secure electronic transmission of both PA requests from health care providers and suppliers to the MA plan, as well as the corresponding response from the plan to the provider or supplier.
• Establish reporting and transparency requirements of MA plans, including percentage and number of specified PA requests that were denied, and the percentage and number of specified requests that were approved, by the plan during the previous plan year using decision support technology, artificial intelligence technology, machine-learning technology, or clinical decision-making technology.
• Require plans to conduct annual reviews of the items and services subject to PA requirements through a process that takes into account input from enrollees and contracted providers and suppliers.
• Require CMS and the Office of National Coordinator for Health Information Technology to submit a report to Congress that defines the term “real-time decision” and details a process for real-time decisions for items and services routinely approved (based on data collected through the transparency requirement) for the purposes of the required electronic prior authorization program.

Lawmakers need to hear from you, their constituents, about why the Improving Seniors’ Timely Access to Care Act needs to be passed this year. Take a moment to send a pre-prepared message to your members of Congress through X or, if you are not active on X, you can send a message by email. In the box to the right of this screen, choose the option that works best for you.