A number of senior healthcare advocates are popping out in assist of the Home of Representatives’ Wednesday choice to move a previous authorization reformation invoice for Medicare Benefit plans.
The invoice, HR 3173, establishes three necessities: Medicare Benefit (MA) plans should create an digital prior authorization program that meets sure requirements, resembling present real-time selections for requests on routine companies; publish prior authorization info annually, together with the share of authorized requests and the common response time; and meet high quality and timeliness requirements of the Facilities for Medicare & Medicaid Providers for prior authorization.
The prior authorization course of determines if a payer will cowl a healthcare service. It has been deemed by many as a time-consuming roadblock to accessing care. Nearly all MA enrollees, or 99%, are in plans that require prior authorization for some companies, a current report by the Kaiser Household Basis discovered.
Altering the method is supported on either side of the aisle: the invoice was sponsored by Reps. Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera (D-CA) and Larry Bucshon (R-IN).
Higher Medicare Alliance, an MA advocacy group, celebrated the Home’s choice to move the Enhancing Seniors’ Well timed Entry to Care Act.
“The Enhancing Seniors’ Well timed Entry to Care Act is commonsense, bipartisan laws to additional elevate the bar of care supply in Medicare Benefit – the place seniors already expertise a 94% satisfaction charge, almost $2,000 in annual shopper financial savings, added advantages, and improved well being outcomes, simply to call just a few. By turning this laws into legislation, Medicare Benefit will likely be even stronger for present and future enrollees,” mentioned Mary Beth Donahue, BMA President and CEO, in a assertion.
The American Hospital Affiliation (AHA), a hospital advocacy group, additionally supported the invoice. AHA is a long-time supporter of reforming prior authorization, not too long ago publishing a scathing report that argued that business insurers’ use of the method burdens suppliers and delays affected person care. It cited a 2021 American Medical Affiliation survey of greater than 1,000 physicians, which discovered 88% of physicians describe the burden related to prior authorization as excessive or extraordinarily excessive.
“This laws takes essential steps to cut back the burden and complexity of prior authorization necessities imposed by Medicare Benefit plans,” mentioned Stacey Hughes, AHA govt vice chairman, in a assertion. “These provisions will assist Medicare sufferers entry the care they want in a well timed method whereas lowering the pressure on our already taxed well being care workforce. The AHA is inspired by Senate assist on companion laws and urges them to take motion on these crucial protections.”
A lobbying group representing the U.S. insurance coverage business neither criticized nor celebrated the invoice’s passage within the Home.
“Medical doctors and clinicians present essential care and life-saving remedy – and so they agree that all of us have to work collectively to keep away from care that’s inappropriate, pointless, and extra expensive,” mentioned David Allen, a spokesperson for America’s Well being Insurance coverage Plans (AHIP), in a press release. “Prior authorization is a vital answer that ensures the care sufferers obtain by Medicare Benefit protection is secure, efficient, confirmed, and reasonably priced. And Medicare Benefit delivers simply that. Defending the worth of MA is crucial as we work collectively to additional enhance prior authorization processes. We sit up for participating additional on this difficulty because the invoice now advances to the Senate.”
Whereas AHIP considers prior authorization as a approach to cut back prices and keep away from pointless care, the method nonetheless wants enhancements, declared Dr. A. Mark Fendrick, director of the College of Michigan’s Heart for Worth-based Insurance coverage Design.
“With research displaying that as much as one-quarter of all well being care expenditures are wasted on companies with no profit to the affected person, we want a sturdy, next-generation prior authorization program to discourage low-value, and even dangerous, care whereas defending entry to wanted remedy and efficient therapies,” Fendrick mentioned in a assertion. “However we want not settle for a false selection between securing prior authorization’s core operate and modernizing its course of. The Enhancing Seniors’ Well timed Entry to Care Act leverages the newest expertise to make sure real-time choice making and a Twenty first-century prior authorization system that advantages sufferers and suppliers alike.”
The invoice now goes to the Senate. Whether it is handed there, it requires President Joe Biden’s signature to be signed into legislation.
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