To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.
About This Bill
Committee
Latest Action · June 12, 2024
Read twice and referred to the Committee on Finance.
This bill establishes new rules for Medicare Advantage plans that use prior authorization, a process where insurers must approve certain medical treatments before patients receive them. Starting January 2026, these plans must publicly report detailed information about their prior authorization practices, including how many requests they approve or deny, how long decisions take, and what technologies they use in decision-making. Beginning January 2027, plans must implement electronic systems for submitting and responding to prior authorization requests, and they must establish protections for seniors such as waiving requirements for high-performing doctors and regularly reviewing which services actually need authorization. The bill also requires the Secretary of Health and Human Services to set timeframes for Medicare Advantage plans to respond to prior authorization requests, potentially as quickly as 24 hours for certain decisions on routine services. Government agencies must report back to Congress by 2027 and 2028 on how well these new requirements are working and whether they improve senior access to care.
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