NANS Supports Seniors’ Act to Improve Timely Patient Access to Care

NANS signs on to support the introduction of the Seniors’ Act or the Improving Seniors’ Timely Access to Care Act, a bipartisan legislation to streamline the use of prior authorizations (PA) under Medicare Advantage (MA) allowing seniors to get timely care and helping reduce administrative burden for health care providers.  

In summary, the Seniors’ Act would:

• Establish an electronic prior authorization (PA) process for MA plans, including a standardization for transactions and clinical attachments. 
  
• Increase transparency around MA prior authorization requirements and their use.
• Provide a pathway for Centers for Medicare and Medicaid Services (CMS) to institute real-time decisions for routinely approved items and services in the future and clarify CMS’ authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services and any other PA request. 
• Expand beneficiary protections to improve enrollee experiences and outcomes. 
• Require the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and other ways to improve the e-PA process, finalized by CMS in January 2024. 

According to an AMA survey of physicians, PA controls lead to unnecessary waste and avoidable patient harm. Reforming the use of prior authorizations in the MA program would impact more than 28 million seniors enrolled in MA plans. 

Sponsored by U.S. Senators Roger Marshall, M.D. (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), Sherrod Brown (D-OH), and U.S. Representatives Mike Kelly (R-PA), Suzan DelBene (D-WA), Larry Bucshon, M.D. (R-IN) and Ami Bera, M.D. (D-CA) and cosponsored by 42 U.S. Senators, 130 House Representative, NANS joins more than 380 organizations representing patients, health care providers, medical technology and biopharmaceutical industry, health plans and others to support the legislation. 

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