Yesterday, the House Energy and Commerce Subcommittee on Health advanced the Improving Seniors' Timely Access to Care Act (H.R. 3514), a major legislative milestone for reform of Medicare Advantage (MA) prior authorization practices.
H.R. 3514 would cement into law regulations issued by the Centers for Medicare and Medicaid Services (CMS) in 2024. Importantly, the legislation would expand upon those regulations by requiring MA plans to report prior authorization data to CMS that would then be made publicly available, including the number of approvals and denials by item and service.
This spring, for the first time, MA and other plans were required to make prior authorization data publicly available. That data, however, is often difficult to find on plan websites, reported in inconsistent formats, and aggregated at a level too high to show what is happening to specific services. H.R. 3514 will streamline transparency requirements and make the information more usable.
The legislation has the support of more than half the U.S. Congress and is endorsed by more than 300 organizations, including ACOFP.
ACOFP members are encouraged to keep up advocacy efforts in support of the bill. Take action here.