H.R. 3173 has made it through the U.S. House of Representatives with bipartisan support and will move to the Senate this fall. Specifically, the bill would establish an electronic prior authorization process, requiring the implementation of a "real-time" decision system for medicare advantage plans.
What is H.R. 3173?
Electronic Prior Authorization
Known as the "Improving Seniors' Timely Access to Care Act" (H.R. 3173) would move Medicare Advantage toward a more transparent and less burdensome process. The bill will not remove the need for prior authorizations. However, it does mandate an electronic and “real time” system to approve routine items/charges.
Improved Visibility
H.R. 3173 requires Medicare Advantage plans to provide more detailed reporting on use of prior authorization, including their rates of approvals, denials, and average time for approvals. These reports will be filed to the U.S. Centers for Medicare & Medicaid Services.
This process has the potential to increase the transparency associated with delays in accessing care caused by prior authorization. This insight would help inform potential next steps to improving patient access.
Expedite Access to Care
The Improving Seniors’ Timely Access to Care Act would change the current prior authorization system by establishing an electronic prior authorization process that will help ensure timely processing for items and services that need to be approved. It would also require the Secretary of the US Department of Health and Human Services to establish a process for “real-time decisions” for items and services that are routinely approved. With electronic prior authorization, health care providers will have more time to do what they were trained to do — attend to their patients and provide them with the care that they need.
Additionally, this bill would prevent plans from requiring prior authorization on any additional surgical or other invasive procedure if this procedure is furnished during the perioperative period of an already-approved procedure.
Electronic Prior Authorization Coming Soon
H.R. 3173 has made it through the U.S. House of Representatives with bipartisan support but still needs to pass the Senate this fall. PatientStudio will be closely monitoring this bill and provide updates to our customers and followers.