U.S. Senator John Cornyn, along with Senators Roger Marshall, Mark Warner, and 44 other Senate colleagues, has introduced the Improving Seniors’ Timely Access to Care Act. The proposed legislation aims to enhance access to care for seniors enrolled in Medicare Advantage plans without incurring additional costs for American taxpayers. It seeks to streamline the prior authorization process that often delays patient care.
Senator Cornyn highlighted the burdens faced by healthcare providers due to administrative procedures: “Doctors and health care providers are too often bogged down by unnecessary burdens, which can lead to delayed care and negative outcomes for patients,” he stated. He added that the legislation would “cut red tape, improve enrollee experiences, and ensure seniors receive the timely care they deserve.”
The bill is cosponsored by a bipartisan group of senators including Maggie Hassan, John Fetterman, Amy Klobuchar, Bill Cassidy, Shelley Moore Capito, John Hickenlooper, James Lankford, Jeff Merkley, Marsha Blackburn, Cynthia Lummis, Cindy Hyde-Smith, Tim Kaine, Jeanne Shaheen, Mike Rounds, Alex Padilla, Bill Hagerty, Andy Kim among others.
Prior authorization requires healthcare providers to obtain pre-approval for services from health plans. While intended to reduce unnecessary care costs, it often results in significant administrative work for clinicians. According to reports nearly three out of four Medicare Advantage enrollees face delays due to this practice.
The Improving Seniors’ Timely Access to Care Act proposes an electronic system for prior authorization in Medicare Advantage plans. It includes standardization of transactions and clinical attachments as well as increased transparency about prior authorization requirements. The bill also clarifies timeframes for e-prior authorization requests and aims at expanding protections for beneficiaries.
Previously supported by a supermajority in both houses of Congress last session—passing unanimously in the House—the bill builds on findings from a 2018 audit by the Office of Inspector General at the Department of Health and Human Services (HHS), which showed that 75% of initially denied requests were eventually approved under Medicare Advantage plans.
Additionally outlined are measures requiring HHS reporting on program integrity efforts related to prior authorizations while ensuring no extra cost burden on taxpayers.
For more details on this legislative proposal’s full text is available online.
