Health

Lawmakers aim to move ‘very quickly’ to pass bill mandating electronic prior authorization for MA plans

Lawmakers behind a bill that would mandate Medicare Advantage plans to adopt electronic prior authorization are confident they can move the legislation quickly through the House.

“I think we can move very quickly. We can push a little bit harder,” said Rep. Mike Kelly, R-Pa., one of the legislation’s co-sponsors. “This is one that makes so much sense and serves a great number of people in our base.”

Lawmakers behind the Improving Seniors’ Timely Access to Care Act held a briefing Thursday on the legislation reintroduced on May 14. The previous version of the legislation, which aims to combat a source of major administrative burden for providers, introduced in the last Congress garnered 280 bipartisan co-sponsors, buoying hopes that it would get a quick vote in the House.

Leaders of the legislation are “open to all opportunities we can see to move legislation quickly,” said Rep. Suzan DelBene, D-Wash., one of the leading sponsors.

DelBene and Kelly both sit on the House Ways & Means Committee, a powerful panel that will consider the legislation.

RELATED: Study: Automated prior authorization may lower costs, improve care for cancer patients

There will also likely be a Senate companion version, Kelly said.

Lawmakers said that while the previous version was popular it was put on the backburner as Congress pursued legislation to combat the pandemic.

The legislation not only requires electronic prior authorization for MA plans, but also requires the Department of Health and Human Services to create a process for faster decisions on items and services that commonly get approved.

While the bill only applies to MA plans, lawmakers hope to eventually tackle more types of insurance such as commercial plans.

“From my perspective, this is a starting point, not an ending point,” said Rep. Ami Bera, D-Calif., during the briefing. “The administrative burden isn’t just limited to Medicare Advantage.”

DelBene added that hopefully “when we show how well this can work it will put more pressure on others to adopt a similar model going forward.”

But a major question remains on whether the legislation would get stiff opposition from the insurance industry.

RELATED: AHIP study finds electronic prior authorization may make it easier for providers to say goodbye to their fax machines

America’s Health Insurance Plans, a top insurance lobbying group, told Fierce Healthcare last Friday after the legislation was introduced that it supports any “collaborative efforts to improve the prior authorization process” but did not take a position either way on the legislation.

The group pointed to the creation in Jan. 2020 of the Fast PATH initiative, a voluntary program where insurers agree to adopt reforms to speed up prior authorization requests including adopting electronic prior authorization.

DelBene said that lawmakers have worked with insurers through the process of drafting the legislation.

Lawmakers also included in the bill a consensus statement signed in 2018 by AHIP and several provider groups such as the American Medical Association and American Hospital Association. The statement outlined areas where payers and providers can agree on improving prior authorization, including creating electronic prior authorization.

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