A bipartisan bill that would require electronic prior authorization processes for Medicare Advantage plans and mandate that HHS set up a real-time decision-making process for medical procedures and items that are commonly approved was introduced in the House of Representatives late last week.1
The Improving Seniors’ Access to Timely Care Act would also:
- Streamline and speed the prior authorization process
- Boost CMS oversight on prior authorization procedures
- Require that MA plans adhere to beneficiary protection standards, like continuity of care
- Mandate that MA plans report on prior authorization use, and approval and denial rates1,2
The legislation builds off the foundation of a 2018 consensus statement issued by America’s Health Insurance Plans and other health care associations that called for prior authorization improvement. House representatives worked with health insurers to craft the bill, and lawmakers plan to fast-track it through the House.3,4
An analysis of a yearlong ePA initiative spearheaded by AHIP involving six major health insurance providers found that more than 7 in 10 providers that established ePA saw accelerated time to patient care.5 Further, nearly 70% of those that implemented ePA experienced reduced waiting times between prior authorization requests and decisions. Using ePA also lessened the burden of time-consuming communication methods such as telephone calls and faxes on providers. More frequent ePA use correlated with greater reduction of other burdens, and better comprehension of prior authorization information.5
Widespread provider adoption of ePA is critical to reap the benefits of the technology, according to the analysis. To foster greater adoption, stakeholders including health plans can:
- Increase ePA availability to providers
- Boost the use of ePA where it’s available
- Focus on training, preparedness and workflow integration
- Incentivize providers to employ ePA.6
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References
- Frieden, Joyce. House Bill seeks to cut red tape on prior authorizations in health care. MedPage Today. May 21, 2021. Accessed May 23, 2021. https://www.medpagetoday.com/practicemanagement/reimbursement/92745
- American Medical Association. Physicians call on Congress to address prior authorization reform. May 14, 2021. Accessed May 23, 2021. https://www.ama-assn.org/press-center/press-releases/physicians-call-congress-address-prior-authorization-reform
- Consensus Statement on Improving the Prior Authorization Process. Accessed May 23, 2021. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc-public/prior-authorization-consensus-statement.pdf
- King, Robert. Lawmakers aim to move “very quickly” to pass bill mandating electronic prior authorization for MA plans. Fierce Healthcare. May 20, 2021. Accessed May 23, 2021. https://www.fiercehealthcare.com/payer/lawmakers-aim-to-move-very-quickly-to-pass-bill-mandating-electronic-prior-authorization-for
- America’s Health Insurance Plans. New analysis shows benefits of electronic prior authorization for patients and providers. March 24, 2021. Accessed May 23, 2021. https://www.ahip.org/new-analysis-shows-benefits-of-electronic-prior-authorization-for-patients-and-providers/
- America’s Health Insurance Plans. Prior authorization: Helping patients receive safe, effective, and appropriate care. March 24, 2021. Accessed May 23, 2021. https://www.ahip.org/prior-authorization-helping-patients-receive-safe-effective-and-appropriate-care/
