Kiggans Supports Legislation to Improve Access to Medicare Services

Jun 19, 2024
Healthcare
Press

WASHINGTON, DC: Last week, Congresswoman Jen Kiggans (VA-02) joined Representatives Mike Kelly (PA-16), Suzan DelBene (WA-01), Larry Buschon (IN-08), and Ami Bera, M.D. (CA-06) in reintroducing the Improving Seniors’ Timely Access to Care Act. This bill, which was unanimously passed by the House during the 117th Congress, would streamline the prior authorization process under Medicare Advantage to make it easier for seniors enrolled in the program to access healthcare services. Specifically, the legislation would establish an electronic prior authorization process (e-PA), increase transparency, set timeline parameters for prior authorization requests, and expand beneficiary protections to improve health outcomes.

“As the only geriatric nurse practitioner in Congress, I am proud to be a voice for our nation’s seniors…especially those who depend on programs like Medicare to cover their healthcare needs,” said Congresswoman Kiggans. “I have seen firsthand the struggles seniors and healthcare providers face trying to navigate Medicare Advantage’s prior authorization process. This bipartisan legislation aims to make this process more efficient and ensure seniors can access the care they need in a timely manner.”

BACKGROUND:

Today there are more than 28 million Americans enrolled in the Medicare Advantage program. Under many of these programs, patients are required to receive prior authorization before receiving certain medical procedures. Currently, the Centers for Medicare & Medicaid Services (CMS) processes the prior authorization process is handled via paper forms sent through the mail. This antiquated process can create significant delays in patients receiving healthcare. 

Specifically, the Improving Seniors’ Timely Access to Care Act would:

  • Establish an electronic prior authorization process for Medicare Advantage plans including a standardization for transactions and clinical attachments. 
  • Increase transparency around Medicare Advantage prior authorization requirements and their use.
  • Clarify CMS’ authority to establish timeframes for e-PA requests including expedited determinations, real-time decisions for routinely approved items and services, and any other PA request.
  • Expand beneficiary protections to improve enrollee experiences and outcomes.
  • Require the Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process.

Read the full bill text here

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