OSMA Supports Introduction of Federal Prior Authorization Legislation
This week, the bipartisan Improving Seniors’ Timely Access to Care Act was introduced in the U.S. Senate. The legislation aims to significantly reform the prior authorization process with Medicare Advantage Plans. OSMA and numerous other physician organizations support this important piece of legislation. OSMA has worked to pass prior authorization legislation at the state level and will be continuing to address additional changes later this year. However, these efforts don’t apply to Medicare Advantage Plans—as they are regulated federally. This new federal initiative will address these plans in the following ways:
- Establish an electronic prior authorization process that would streamline approvals and denials.
- Establish national standards for clinical documents that would reduce administrative burdens health care providers and Medicare Advantage plans.
- Create a process for real-time decisions for certain items and services that are routinely approved.
- Increase transparency that would improve communication channels and utilization between Medicare Advantage plans, health care providers, and patients.
- Ensure appropriate care by encouraging Medicare Advantage plans to adopt policies that adhere to evidence-based guidelines.
- Require beneficiary protections that would ensure the electronic prior authorization serves seniors first.
OSMA will be working with Senators Brown and Portman to pass this important legislation. We will continue to update OSMA members on its progress and how you can help advocate for its passage.