Kelly applauds UnitedHealth announcement that it will cut prior authorizations in response to Kelly-led bill
WASHINGTON, D.C. -- Today, UnitedHealth announced it will dramatically reduce its use of prior authorizations for Medicare Advantage patients, in addition to commercial and Medicaid patients. This announcement comes after a years-long effort, led by U.S. Reps. Mike Kelly (R-PA) and Suzan DelBene (D-WA), to protect seniors and Medicare Advantage enrollees from unfair prior authorization denials and extended waiting periods.
That bill, the Improving Seniors’ Timely Access to Care Act (H.R. 3173), was unanimously passed in the U.S. House last year by a voice vote. The bill substantially re-wrote the rules for prior authorization by establishing an electronic prior authorization process (as opposed to the current paper-based system) and requiring decisions to be issued from insurers in real time. It improves 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, while encouraging plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.
In response to the Improving Seniors’ Timely Access to Care Act, the Department of Health and Human Services proposed three December 2022 rules to administratively enact prior authorization reform. The total savings from these rule changes is estimated to be $15 billion over ten years.
“It’s my hope that today’s announcement by UnitedHealth is the first of many announcements from commercial insurers about much-needed reforms to prior authorization," said Rep. Kelly, Member of the Ways & Means Subcommittee on Health. "Americans, particularly seniors, deserve to receive timely access to care. Waiting days or weeks only to be denied a routine medical service can be crushing to a family. Decisions about health care should be between a patient and their doctor. Bureaucratic paperwork should never be a barrier.”
“The news that UnitedHealthcare and other private Medicare Advantage plans are finally reducing burdensome paperwork that is a regular barrier to seniors receiving the care they deserve is a step in the right direction. But seniors and their families shouldn’t be beholden to corporate goodwill. These changes should have been instituted long ago,” said DelBene. “The rules should be the same across Medicare Advantage and there needs to be greater transparency and accountability in the program. That’s why we must see today’s news as adding urgency to passing legislation that brings this archaic practice into the 21st century.
BACKGROUND
A prior authorization is a process wherein insurance plans require providers to obtain approval 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.
Earlier this year, HHS’s independent watchdog released a report illustrating the abuse of prior authorization in Medicare Advantage.
The Improving Seniors’ Timely Access to Care Act (H.R. 3173) 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.
Rep. Kelly introduced the legislation with Representatives Suzan DelBene (WA-01), Ami Bera, M.D. (CA-07), and Larry Bucshon, M.D. (IN-08). When it passed last year, it had over 300 cosponsors in the House and the endorsement of over 500 organizations.