Faster Medicare Advantage Care: New Rules for Prior Authorization.
This bill establishes mandatory standards for Medicare Advantage (MA) plans to speed up the process of obtaining approval for medical services (prior authorization). Citizens will benefit from increased transparency regarding insurer decisions and reduced waiting times for the approval of routine medical procedures. These changes aim to ensure seniors receive necessary healthcare more promptly.
Key points
Mandates the creation of a secure electronic prior authorization (PA) system by 2027, excluding faxes and non-standard portals, to streamline communication between doctors and insurers.
MA insurers must publicly report detailed data on PA approvals, denials, and the average time taken for decisions, starting in 2026.
The Secretary of Health may set shorter deadlines (e.g., 24 hours) for PA decisions, especially for expedited or routinely approved services.
MA plans can waive or modify PA requirements for high-performing providers who adhere to medical guidelines, potentially simplifying access to care for enrollees.
Expired
Citizen Poll