Faster Healthcare Access for Seniors: New Prior Authorization Rules
This act amends Medicare Advantage plans to streamline the prior authorization process for medical services. Seniors can expect quicker decisions regarding their healthcare, and insurance plans will be required to operate with greater transparency. The goal is to improve access to necessary medical services and reduce administrative burdens.
Key points
Medicare Advantage plans must implement an electronic prior authorization program to reduce decision times.
For routinely approved services, prior authorization decisions are to be made in real-time, with exceptions for extenuating circumstances.
Insurance plans will be required to publish data on prior authorizations, including approval and denial rates, enhancing transparency.
Enrollee protection standards are introduced, including potential waivers of prior authorization for high-performing providers.
The maximum response time for urgent requests is shortened to 24 hours, and for standard requests to 7 days.
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