Congressional Support for Medicare Prior Authorization Reform Bill Building

On Oct. 9, legislation supported by ASCP to reform prior authorization policies within Medicare Advantage (MA) plans reached a significant achievement: a majority of members of the U.S. House of Representatives has signed on as co-sponsors of the legislation. Currently, 221 members of the House (155 Democrats, 86 Republicans) have co-sponsored HR 8702, the Improving Seniors’ Timely Access to Care Act. The Senate version of the bill, S. 4532, similarly enjoys support from the majority of U.S. Senators.

In addition, the measure recently received excellent news from the Congressional Budget Office (CBO). The measure received a $0 “score”, meaning that the measure is not expected to increase federal spending. CBO scores are an important factor that weighs heavily on the chances a bill might be enacted.

Prior authorization has been identified as the #1 administrative burden by healthcare providers, and three out of four MA enrollees are subject to these burdens. Moreover, a recent audit by the U.S. Department of Health and Human Services (HHS) found that MA plans ultimately approved 75 percent of requests that were originally denied. Additionally, HHS  found that MA plans were incorrectly denying Medicare beneficiaries’ access to services even though they met coverage requirements. 

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