A bill aiming to reform the Medicare Advantage prior authorization process was included in a package of healthcare legislation that passed the House Ways and Means Committee and is headed to the full House for further consideration.
The legislation is similar to a bill that passed the House last year but was never called to a vote in the Senate.
According to a July 26 news release from Pennsylvania Rep. Mike Kelly, one of the bill's sponsors, the proposed legislation would:
1. Establish an electronic prior authorization process.
2. Require HHS to establish a process for real-time decisions for items and services that are routinely approved.
3. Improve transparency by requiring Medicare Advantage plans to report to CMS on the extent of their prior authorization use and the rate of approvals or denials.
4. Encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines in consultation with physicians.