Sen. Cramer, Colleagues Introduce Improving Seniors’ Timely Access to Care Act

Source: United States Senator Kevin Cramer (R-ND)

WASHINGTON – U.S. Senator Kevin Cramer (R-ND) co-sponsored theImproving Seniors’ Timely Access to Care Act, bipartisan and bicameral legislation to improve timely access to quality care for seniors under Medicare Advantage introduced by Senators Roger Marshall (R-KS), Krysten Sinema (D-AZ), and John Thune (R-SD). Improving Seniors’ Timely Access to Care Act will modernize the way Medicare Advantage plans and health care providers use prior authorization, a tool used by health plans to reduce improper payments and unnecessary care by requiring providers to get pre-approval for medical services. This legislation addresses the primary administrative issue for physicians today, and will make the delivery of health care more patient and doctor friendly.

“This bipartisan legislation helps ensure health care is intentionally focused on each individual patient and their needs, not on burdensome or unnecessary paperwork. Our common-sense bill cuts the red tape to provide seniors in North Dakota with quality care in a timely manner,” said Senator Cramer.

The Improving Seniors’ Timely Access to Care Act has amassed support from over 320 national and state organizations representing patients, health care providers, medical device manufacturers, and health IT companies across the country. Learn more here.

Background:

Prior authorization is a valuable tool, but it is not without fault. The current system of unconfirmed faxes of a patient’s medical information or phone calls by clinicians takes precious time away from delivering quality and timely care. Prior authorization continues to be the primary administrative burden identified by health care providers and nearly four out of five Medicare Advantage enrollees are subject to unnecessary delays. In recent years, the Office of the Inspector General at the U.S. Department of Health and Human Services raised concernsafter an audit revealed that Medicare Advantage plans ultimately approved 75% of requests that were originally denied.

Health plans, health care providers, and patients agree that the prior authorization process must be improved to better serve patients and reduce unnecessary administrative burdens for clinicians. In fact, leading health care organizations released a consensus statement to address some of the most pressing concerns associated with prior authorization. Building on these principles, the bipartisan legislation would:

establish an electronic prior authorization process that would streamline approvals and denials;
establish national standards for clinical documents that would reduce administrative burdens health care providers and Medicare Advantage plans;
create a process for real-time decisions for certain items and services that are routinely approved;
increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients;
ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines; and
require beneficiary protections that would ensure the electronic prior authorization serves seniors first.

Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Ami Bera, M.D. (D-CA), and Larry Bucshon, M.D. (R-IN) introduced companion legislation in the U.S. House of Representatives.

Click here to read the bill text.