Legislation aimed at reducing delays when Medicare Advantage plans require preapproval for care could hit the House floor under fast-track rules for bills that have broad support.
The bill, sponsored by Rep. Mike Kelly, R-Pa., targets use of prior authorization in Medicare Advantage — in which insurers approve or deny services before they can be delivered.
The legislation would require insurers’ plans to adopt electronic systems that use standardized transactions, which proponents say will reduce delays caused when health care providers are forced to navigate through various payer portals or send information by fax. It would also require plans to submit a range of data to the federal government, including which services are subject to prior authorization requirements and the percentage and number of requests approved and denied.
The use of prior authorization has become widely loathed by the public and health care providers, who say it delays access to needed care. Insurers defend the practice as necessary to prevent patients from receiving unnecessary care. Its use has been scrutinized in Medicare Advantage, the private option that now covers more than half of Medicare beneficiaries.
