Nearly 300 members of Congress have joined forces to urge federal regulators to take action in reducing burdensome requirements associated with Medicare Advantage (MA).
These requirements have been identified as potential barriers that hinder the timely delivery of care to nursing homes and other patients.
Congressional Coalition Urges Reforms to Streamline Medicare Advantage
In a joint letter to the Centers for Medicare & Medicaid Services (CMS), the lawmakers called for a range of reforms to streamline the prior authorization process and improve patient outcomes.
The letter, spearheaded by Senators John Thune and Sherrod Brown, emphasizes the need for a real-time mechanism to support quick electronic prior authorization (PA) decisions for routinely approved services.
This proposed mechanism aims to enhance patient care, reduce provider burden, and eliminate unnecessary delays.
Numerous organizations representing patients, physicians, hospitals, and healthcare experts have expressed their support for this initiative, which includes a real-time process for routinely approved items and services.
The lawmakers highlight the challenges faced by skilled nursing providers due to the prior authorization requirements imposed by MA plans.
The recently finalized 2024 Medicare and Medicare Advantage rule by CMS initiated some changes to prior authorization requirements.
However, lawmakers are urging further steps to be taken to ensure timely access to care.
They call for a 24-hour deadline for MA plans to respond to prior authorization requests for urgently needed care.
Support from Provider Groups
The transparency efforts proposed align with the Improving Seniors’ Timely Access to Care Act, which garnered support from approximately 500 provider groups during its passage in the House last year.
These groups, including LeadingAge and the American Geriatrics Society, recognize the need for reform and have been working collaboratively to address concerns related to prior authorization practices.
The legislation has been reintroduced in both chambers of Congress this session, signaling a continued commitment to improving access to care for seniors.
The lawmakers acknowledge the burdensome nature of the current prior authorization process, which can take up to 72 hours under existing regulations.
They express concerns about the potential life-or-death implications of delayed care and stress the importance of immediate access to necessary treatments.
The proposed reforms aim to alleviate these challenges and create a more efficient system that benefits both patients and healthcare providers.
Real-time decisions and faster approvals have demonstrated cost savings for providers, making them an attractive incentive to promote the implementation of streamlined processes.
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