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September 23, 2022

Medicare Advantage Prior Authorization Bill Passed by the House

On September 14, the U.S. House of Representatives passed the Improving Seniors’ Timely Access to Care Act of 2021 (HR 3173) to address what some see as problematic prior authorization practices of Medicare Advantage plans. For example, HHS recently issued a report which found that approximately 13% of denied prior authorization requests from the 15 largest Medicare Advantage Organizations during a week-long period in June 2019 met fee-for-service Medicare coverage rules. In light of these concerns, the Act would requires Medicare Advantage Plans to (1)  establish an electronic program that follows set standards for prior authorizations; (2) publish prior authorization information annually, including the percentage of approved requests and the average time for responding; and (3) meet other prior authorization standards set by CMS relating to the timeliness and quality of prior authorization determinations. The bill now moves to the Senate for consideration.

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