House passes Kelly-led bill improving health care for millions of Pennsylvania seniors, cuts red tape

WASHINGTON, D.C. -- Today, U.S. Rep. Mike Kelly (R-PA) voted for the Improving Seniors’ Timely Access to Care Act (H.R. 3173), legislation that would make it easier for more than 2.7 million Pennsylvania seniors enrolled in Medicare, including the 1.2 million enrolled in Medicare Advantage, to get the care they need and improve health outcomes. The bill would modernize the antiquated prior authorization process in Medicare Advantage, which often still requires faxing documents to insurance companies.

The bill unanimously passed the U.S. House by a voice vote.

Many Medicare Advantage plans require providers to obtain prior authorization for certain medical procedures and tests before they can provide care to their patients. Prior authorization can play a role in ensuring people receive appropriate treatments and help control the cost of care. However, when misused, prior authorization can delay medically necessary care and result in administrative burdens for providers.

“The current prior authorization process in Medicare Advantage often requires doctors and patients to call or fax documents back and forth with insurance companies. When seniors go to the doctor, the focus should be on their health, not bureaucratic paperwork,” said Rep. Kelly. “That’s why I have led and ultimately voted for the Improving Seniors’ Timely Access to Care Act so Pennsylvania seniors can get the care they need when they need it.”

WATCH: Click here to watch a clip of Rep. Kelly's speech on the U.S. House floor supporting the Improving Seniors’ Timely Access to Care Act (H.R. 3173).
 

The bill would:

• Establish an electronic prior authorization process.
• Require the U.S. Department of Health & Human Services (HHS) to establish a process for “real-time decisions” for items and services that are routinely approved.
• Improve transparency by requiring Medicare Advantage plans to report to the Centers for Medicare & Medicaid Services (CMS) on the extent of their use of prior authorization and the rate of approvals or denials.
• Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.
• Earlier this year, HHS’s independent watchdog released a report illustrating the abuse of prior authorization in Medicare Advantage.

Rep. Kelly introduced the legislation with Representatives Suzan DelBene (WA-01), Ami Bera, M.D. (CA-07), and Larry Bucshon, M.D. (IN-08). It has over 300 cosponsors in the House and the endorsement of over 500 organizations.

Prior Authorization Fast Facts

• 13 percent of denied prior authorization requests met Medicare’s coverage rules and
  should not have been denied.
• One in four physicians report that prior authorization has led to a patient being
  hospitalized.
• Doctors spend an average of 13 hours a week completing prior authorization paperwork.
• 88 percent of doctors describe this burden of prior authorization as high or extremely high.

In July, the House Ways & Means Committee advanced the bill to the floor. The bill now goes to the Senate for consideration where it also has strong bipartisan support.