MMA Supports Bill to Take on Prior Auth Abuse by Medicare Advantage Plans

June 13, 2024

The MMA has signed on to support federal bipartisan legislation that would tackle the overuse and abuse of prior authorization (PA) by Medicare Advantage (MA) plans.  

Introduced June 12, the Improving Seniors’ Timely Access to Care (Seniors’) Act, is co-sponsored by Sen. Amy Klobuchar and Rep. Betty McCollum and has the support of more than 380 organizations and 42 senators and 130 house members. 

The bill would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.  

In efforts to promote swift passage in Congress, the bill sponsors made modest adjustments to the legislation to align with CMS’ final e-PA rule and to reduce the Congressional Budget Office score. Changes include a requirement for CMS to issue a report on implementing real-time decisions, an analysis on enrollee impact, and clarifying CMS’s authority to modify the timeframes for making PA determinations.