BMA Supports Bill on Medicare Advantage Prior Authorizations
June 13, 2022Better Medicare Alliance (BMA) has endorsed HR 3173, the Improving Seniors’ Timely Access to Care Act, a law that seeks to reform prior authorization in Medicare Advantage.
The law, according to its sponsors, seeks to formalize an electronic prior authorization process as well as a real-time decision process for routine products and services. Additionally, Medicare Advantage plans would have to submit a report to CMS that relays their prior authorization utilization rate, approval rate, and denial rate. Finally, it would encourage an industry standard for prior authorization programs.
The BMA’s endorsement and the law itself are timely as a report from the Office of Inspector General (OIG) recently indicated that Medicare Advantage plans have denied or delayed prior authorizations or payment requests. Based on the agency’s assessment, 13 percent of prior authorization requests that Medicare Advantage plans denied would have been approved under fee-for-service Medicare.