Grassroots Update: A Win for Medicare Advantage

We are pleased to announce that The Improving Seniors’ Timely Access to Care Act, federal legislation aimed at reducing delays when Medicare Advantage plans require prior approval for care, could move forward in Congress. The legislation, officially H.R. 3515/S. 1816, received the required 290 co-sponsors and will be placed on the consensus calendar. This allows legislation to move outside of the traditional committee process, fast-tracking it for markups and votes.

First introduced by Washington’s Rep. Susan DelBene (WA-01), the legislation will require MA plans to implement secure, standardized electronic systems for submitting and responding to prior authorization requests. It will also require detailed prior authorization data be reported to CMS, including denial rates, appeal outcomes, and use of AI technologies in determinations. In 2024 alone, 3.7 million requests for prior authorization were denied.

WHCA advocated against prior authorization on Capitol Hill last week. We’d love to hear from you as we continue to track and gain understanding of the local impact of prior authorization. If you have MA plan-holding residents or patients negatively impacted by prior authorization, reach out to Aidan Swayne today. Your help is greatly appreciated.