What You Need to Know
- The Improving Seniors' Timely Access to Care Act would create an electronic preauthorization process and pave the way for instant approvals of certain procedures.
- The Better Medicare Alliance, a coalition with many insurer members, has now endorsed the bill, which could improve its chances of passage.
- The bill has strong, bipartisan support in both the House and the Senate.
The Better Medicare Alliance — a group with strong ties to Medicare Advantage plan issuers — has decided to support a bill intended to streamline preauthorization of care in the Medicare Advantage program.
If the bill becomes law, and if it works as supporters predict, it could slash the number of older clients who come in with complaints about getting health plans to approve the care recommended by their physicians.
What It Means
Traditionally, many clients with the means to pay monthly premiums for Medicare supplement insurance have combined “original Medicare” coverage with Medicare supplement insurance, because of concerns about Medicare Advantage plans’ use of provider networks and active management of care.
If a Medicare Advantage preauthorization bill becomes law and leads to a significant improvement in how smoothly enrollees get access to care, it could make Medicare Advantage plans more appealing for some clients.
Monthly premium costs for Medicare Advantage plan enrollees are often lower than total costs for clients using original Medicare with Medicare supplement insurance, and that means affected clients may be able to reduce the amount of income allocated for health insurance premiums.
Health plans use preauthorization procedures to review health care providers’ recommendations for certain types of care, such as CAT scans, expensive medications and surgery.
Health plans have argued that well-run preauthorization programs and related programs are critical to protecting patients against drugs and procedures that might cost too much, might be unnecessary, or that might even hurt them.
Provider groups have acknowledged that some kinds of review might be necessary, but they have argued that, in practice, review programs often appear to be rigid, arbitrary and difficult for physicians to work with.
H.R. 3173, the House version of the bill, was introduced in May 2021 by Rep. Suzan DelBene, D-Wash.
The bill is under the jurisdiction of the House Ways and Means Committee and the House Energy and Commerce Committee, which have not yet held hearings on the bill.
H.R. 3173 has 173 Democratic co-sponsors and 123 Republican co-sponsors.
Sen. Roger Marshall, R-Kansas, introduced the Senate companion bill, S. 3018, in October 2021.