AHA expresses support for bill establishing requirements for use of prior authorization under MA plan

Jun 04, 2021 - 01:42 PM
seniors-opioids

The AHA today expressed support for the Improving Seniors’ Timely Access to Care Act of 2021 (H.R. 3173), bipartisan legislation that would establish requirements for the use of prior authorization under Medicare Advantage plans.

“America’s hospitals and health systems are committed to ensuring patient access to the highest quality care in a timely manner,” AHA said today in a letter to the bill’s sponsors, Reps. Suzan DelBene, D-Wash.; Mike Kelly, R-Pa.; Ami Bera, D-Calif.; and Larry Bucshon, R-Ind. “Your bill seeks to streamline and improve prior authorization processes, which would help providers spend more time on patients, instead of paperwork. We commend you for your focus on this important issue and look forward to working with you to make improvements to the prior authorization process to ensure patient access.”

Prior authorization is a tool that can help align patients’ care with their health plan benefit structure and facilitate alignment with clinical best practices when used appropriately. However, these processes vary widely among health plans and insurers, and the lack of standardization can be confusing and burdensome for providers. Certain health plan utilization management practices can, when poorly structured or implemented, create unnecessary delays in care that can negatively affect patients.
 

 

Related News Articles

Headline
AHA shares concerns, recommendations with CMS on WISeR model
The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address…
Headline
OIG says MA, Medicaid managed care plans have limited, inaccurate behavioral health provider networks 
A report by the Department of Health and Human Services Office of the Inspector General found that many Medicare Advantage and Medicaid managed care plans…
Headline
Medicare open enrollment for 2026 begins
Medicare open enrollment for 2026 began Oct. 15 and runs through Dec. 7. During the annual enrollment period, Medicare-eligible individuals can check their…
Headline
AHA encourages MedPAC to refine analysis of MA enrollment impacts on patients, providers
The AHA Oct. 3 responded to the Medicare Payment Advisory Commission’s recent analysis on the financial impacts of Medicare Advantage enrollment growth on…
Headline
CMS finalizes Medicare Part C Utilization Management Annual Data Submission requirements 
The Centers for Medicare & Medicaid Services Sept. 30 issued a memo, through the Health Plan Management system, finalizing the Medicare Advantage…
Headline
AHA provides recommendations to HHS, CMS for insurers to adhere to prior authorization pledge 
The AHA Sept. 29 sent recommendations to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure…