The U.S. House Ways & Means Committee advanced a bill to reform the Medicare Advantage prior authorization process.
The bill will now go before the full House for a vote this fall, according to a July 27 news release from Rep. Suzan DelBene, D-Wash., one of the bill's sponsors.
Among other things, the bill would establish an electronic prior authorization process and require Medicare Advantage plans to report to CMS the extent of their use of prior authorization and the rate of approvals or denials.
The bill was originally introduced in 2021. Its sponsors pushed for action on the legislation this spring after an HHS Office of the Inspector General's report found that 13 percent of Medicare Advantage prior authorization request denials would have been approved for beneficiaries under original Medicare coverage rules. The report also found 18 percent denied payment requests met Medicare coverage rules and Medicare Advantage Organization billing rules.
Reps. Mike Kelly, R-Pa., Ami Bera, D-Calif., and Larry Bucshon, R-Ind. are sponsoring the bill, along with Ms. DelBene.