House Committee Advances Medicare Advantage Prior Authorization Bill

August 1, 2022

On July 27, the House Ways & Means Committee unanimously voted to advance the Improving Seniors’ Timely Access to Care Act (H.R. 8487), a bipartisan bill to streamline prior authorization requirements under Medicare Advantage (MA) plans.

During the Committee’s markup, members expressed support to reform the prior authorization process to ensure that patients receive timely access to care. They also highlighted the bill’s strong support from health care organizations, including the American Hospital Association. GNYHA strongly supports the bill’s goal of modernizing the MA prior authorization process.

Sponsored by Representative Suzan DelBene (D-WA), the bill would establish an electronic prior authorization process and reduce how long a health plan can consider a prior authorization request. It also would create a “real-time decisions” process for routinely approved services and require MA plans to report on their prior authorization use and rate of approvals and denials. In addition, the bill would establish enrollee protection standards, including requiring MA plans to adopt transparent prior authorization programs (developed with enrollee and provider input) and conduct annual reviews of items and services subject to prior authorization.

The bill has strong bipartisan support in the House and Senate. A previous version of the House bill garnered the support of 309 representatives. The Senate version (S.3018) has 37 bipartisan cosponsors. The full House is expected to consider the bill. If it passes the House, the bill would require Senate approval before it could be sent to the President for his signature.