Senator Collins Co-Sponsors Bipartisan Bill to Streamline Care for Seniors

The bill would reform prior authorization system that continues to be #1 administrative burden for health care providers

Washington, D.C. – U.S. Senator Susan Collins (R-ME) co-sponsored the Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would improve timely access to quality care for seniors under Medicare Advantage. Specifically, the bill would modernize the way Medicare Advantage plans and health care providers use prior authorization. This legislation addresses the number one administrative issue for physicians today and will make the delivery of health care more patient and doctor friendly.

 

“Mainers depend on quality, timely health care delivered by experienced providers who

know their patients’ needs best,” said Senator Collins. “This bill would modernize and streamline the prior authorization process, ensuring that medical providers can continue to provide efficient care to patients without unnecessary delay. I urge my colleagues to support this commonsense legislation and make it easier for seniors to receive the critical care they need.”

 

Prior authorization is a tool used by health plans to reduce spending from improper payments and unnecessary care by requiring physicians and other health care providers to get pre-approval for certain medical services. However, the current system of unconfirmed faxes of a patient’s medical information or phone calls by clinicians takes precious time away from delivering quality and timely care.

 

Prior authorization continues to be the #1 administrative burden identified by health care providers, and nearly four out of five Medicare Advantage enrollees are subject to unnecessary delays. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services raised concerns after an audit revealed that Medicare Advantage plans ultimately approved 75 percent of requests that were originally denied.

 

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization. Building on these principles, the bipartisan legislation would:

 

• Establish an electronic prior authorization process that would streamline approvals and denials;

 

• Establish national standards for clinical documents that would reduce administrative burdens health care providers and Medicare Advantage plans;

 

• Create a process for real-time decisions for certain items and services that are routinely approved;

 

• Increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients;

 

• Ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines; and

 

• Require beneficiary protections that would ensure the electronic prior authorization serves seniors first.

 

The Improving Seniors’ Timely Access to Care Act was introduced by Senators Roger Marshall (R-KS), Kyrsten Sinema (D-AZ), and John Thune (R-SD).

 

The bill amassed support from over 320 national and state organizations representing patients, health care providers, medical device manufacturers, and health IT companies across the country.