Representative Mike Kelly, alongside colleagues Representatives Suzan DelBene, Ami Bera, M.D., and John Joyce, M.D., as well as Senators Roger Marshall, M.D. and Mark Warner, have reintroduced the Improving Seniors’ Timely Access to Care Act (H.R. 3514). The bill aims to modernize the prior authorization process for Medicare Advantage enrollees.
Representative Kelly highlighted the necessity of updating this process due to its impact on nearly 33 million Americans enrolled in Medicare Advantage. “Streamlining this process will allow our Nation’s seniors to receive the care they are entitled to more efficiently,” he stated.
Congresswoman DelBene emphasized the need for legislative action: “We’ve made important incremental headway in helping seniors get the medical care they deserve with the administration’s prior authorization regulations. However, we must go further and enshrine these advancements into law.”
Rep. John Joyce pointed out issues with bureaucratic decision-making: “When decisions on patient care are made by bureaucrats with no experience treating patients, care is often delayed or denied altogether.”
Dr. Ami Bera expressed concerns from a physician’s perspective: “The broken prior authorization process delays needed care and frustrates both seniors and their physicians.”
Prior authorization requires pre-approval for medical services but has been criticized for causing delays and administrative burdens. A report from the U.S. Department of Health and Human Services Office of Inspector General revealed that many requests initially denied by Medicare Advantage plans were later approved.
The proposed legislation seeks to establish an electronic prior authorization process for Medicare Advantage plans, increase transparency, clarify authority over e-prior authorizations, expand beneficiary protections, and require reporting on program improvements.
This reintroduction follows previous efforts where similar legislation passed unanimously in the House during the 117th Congress.
