Minnesota Medical Association Signs On to Letter Asking Congress to Improve Prior Auth in Medicare

MINNEAPOLIS, Minnesota, Sept. 12 -- The Minnesota Medical Association issued the following news:

The MMA, along with dozens of state medical associations and specialty societies, signed on to a letter to the House of Representatives that asks members to support efforts to streamline prior authorization processes by Medicare Advantage plans. The bill, HR 3107, is called the "Improving Seniors' Timely Access to Care Act."

The legislation is intended to help protect patients from unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing oversight and transparency of health insurance for America's seniors.

The bill calls for:

* Creating an electronic prior authorization program including the electronic transmission of prior authorization requests and responses, and a real-time process for items and services that are routinely approved

* Improving transparency by requiring plans to report to CMS on the extent of their use of prior authorization and the rate of approvals or denials

* Requiring plans to adopt transparent prior authorization programs that are reviewed annually, adhere to evidence-based medical guidelines, and include continuity of care for individuals transitioning between coverage policies to minimize any disruption in care;

* Holding plans accountable for making timely prior authorization determinations and to provide rationales for denials

* Prohibiting additional prior authorization for medically necessary services performed during a surgical or invasive procedure that already received, or did not initially require, prior authorization.