New Legislation Aims to Help Seniors Get Care Quickly
New legislation has recently been passed by the US House of Representatives to help those using the Medicare Advantage program and now awaits approval by the Senate. This act is designed to help seniors get the care they need more quickly, but what does it do and how?
The "Improving Seniors Timely Access to Care Act" otherwise known as H.R.3173 [1][2] is designed to amend the Social Security Act. This act, if passed, will add new language to speed up the process to have a prior authorization approved. It will also add transparency requirements to report data on prior authorizations such as the number of denials, appeals and approval times.
Medicare Advantage patients have struggled with long wait times. Simple treatments can take weeks or even months for approval. For senior aged patients, especially those with chronic issues, the wait for relief can worsen their condition. According to the American Medical Association, 34% of physicians reported this "has led to a serious adverse event for a patient in their care"[3]. Many seniors struggle with timely delivery of their medication. Additionally, the AMA reported that 93% of physicians reported delays with prior authorizations and 82% reported treatment abandonment due to long waits. [3] The new additions will include setting deadlines for approvals.
New reporting requirements are included as well to add transparency. The American Hospital Association (AHA) raises these concerns specifically in their letter to the Committee on Ways and Means[4]. Specifics of the approval process are normally proprietary. Without this information, it is hard for patients and providers to predict the outcome of a request. The AHA also raises concerns with excessive denials based on findings from the US Department of Health and Human services[5]. The findings show that a significant number of denials actually met criteria.
What's next? The U.S. Senate has received the bill as of September 15th, 2022 and will need to vote on the legislation. If signed into law, these changes could come into effect by July 2023. For now, we will all have to wait and see if this passes the next hurdle or not. What are your thoughts on this bill? Do you think it will help your practice? Let us know, below!
[1] H. R. 3173 https://www.congress.gov/bill/117th-congress/house-bill/3173/text
[2] 42 USC 1395w-22: Benefits and beneficiary protections http://uscode.house.gov/view.xhtml?req=(title:42%20section:1395w-22%20edition:prelim)
[3] 2021 AMA prior authorization (PA) physician survey https://www.ama-assn.org/system/files/prior-authorization-survey.pdf
[4] AHA Voices Support for the Improving Seniors’ Timely Access to Care Act of 2022 (H.R. 8487) https://www.aha.org/lettercomment/2022-07-27-aha-voices-support-improving-seniors-timely-access-care-act-2022-hr-8487
