The Improving Seniors’ Timely Access to Care Act, bipartisan legislation that would improve timely access to quality care for seniors under Medicare Advantage, unanimously passed the House of Representatives on September 14, 2022. The bill is now in the hands of the Senate. The act requires Medicare Advantage plans to establish an electronic prior authorization program, meet new transparency requirements and comply with shorter turnaround times for rendering decisions on requests for prior authorization. 

The act includes requirements related to “real-time” decision-making for items identified by the Secretary of Health and Human Services as being “routinely approved.” It also includes new annual data submission related to prior authorization requests and outcomes, including the type of technology used when rendering a determination. The timeframe to render decisions would be shortened to seven days for non-expedited requests, and 24 hours for expedited requests. 

Medicare Advantage plans would have slightly more time to implement the new requirements than originally proposed in 2021. Electronic prior authorization program requirements would go into effect for the third plan year after the date of enactment, with the transparency requirements shortly following and becoming effective the fourth year after date of enactment.  

ATTAC Consulting Group has expertise in all health plan regulatory and operational areas. Contact ATTAC about how our structured yet flexible approach can help your plan achieve success with your mission-critical initiatives.