House Passes Medicare Preauthorization Bill by Voice Vote

What You Need to Know

H.R. 3173 would create an electronic preauthorization process and could lead to instant approvals for some procedures.
Insurance industry groups have supported the bill.
The bill has had strong bipartisan support in both the House and the Senate.

Members of the House today passed H.R. 3173 — the Improving Seniors’ Timely Access to Care Act — by a voice vote.

The bill would change the rules Medicare Advantage plans use when determining ahead of time whether they will pay for a course of care recommended by a patient’s physician.

Both H.R. 3173 and the Senate companion bill, S. 3018, have had strong support from both Democrats and Republicans.

But Rep. Kevin Brady, R-Texas, who is the highest-ranking Republican on the House Ways and Means Committee, which shapes federal spending, today warned in a statement that he has concerns about a Congressional Budget Office estimate that the rule changes could cost $16.2 billion over 10 years.

What It Means

H.R. 3173 could become law, but the House voice vote approving it does not mean that final passage through Congress is a sure thing.

The Background

The Medicare Advantage program gives private insurers a way to offer Medicare enrollees coverage that looks more like ordinary commercial health coverage, and less like original Medicare coverage, which was developed more than 50 years ago and has elaborate rules for sharing costs with the enrollees.

In an effort to improve the quality of care and reduce unnecessary use of care, Medicare Advantage plans often use preauthorization programs and other rules and programs to see whether the requested drugs, procedures and other forms of care proposed appear to make sense.

Doctors have argued that, in practice, many of the preauthorization programs are slow, intrusive and demeaning, and may require them to explain their recommendations to care review workers who know nothing about the doctors’ fields of practice.

Rep. Suzan DelBene, D-Wash., introduced H.R. 3173, the House Medicare Advantage preauthorization rule change bill, in May 2021. It has 189 Democratic co-sponsors and 134 Republican co-sponsors.

Friction?

H.R. 3173 could sail through the Senate and onto the desk of President Joe Biden.

One possible remaining source of resistance to quick passage is the $16.2 billion CBO bill cost estimate.

Brady said in his statement that, because of the bill’s cost, Congress must find spending cuts or sources of revenue to offset the impact of the bill on the federal budget deficit.

“I had expected this basic responsibility would have occurred in the House,” Brady said. “Now I strongly urge the Senate to work with us to resolve the cost issue, so this vital bill becomes law.”

Brady’s statement could be a sign that discussions about “pay-fors” could be a source of friction as H.R. 3173 heads toward the Senate floor.