WHA Urges Wis. Congressional Delegation to Support Legislation Streamlining Medicare Advantage Prior Authorization

November 18, 2021

The Wisconsin Hospital Association is urging Wisconsin's congressional delegation to support legislation aiming to help streamline the prior authorization process for Medicare Advantage plans. In a November 15 letter sent to all 10 members of Wisconsin's congressional delegation, WHA President and CEO Eric Borgerding urged lawmakers to support H.R.3173/S.3018—the Improving Seniors' Timely Access to Care Act of 2021.
This legislation would establish various standardization and transparency requirements for the prior authorization practices of health insurers offering Medicare Advantage Plans. Among the reforms included in the legislation are:
  • Establishing an electronic prior authorization program to provide real-time decisions in response to requests for items and services that are routinely approved;
  • Annually publishing transparency information such as the percentage of requests approved and the average response time; and
  • Creating quality and timeliness standards for prior authorization determinations.
The goal of the reforms included in this legislation are to help reduce unnecessary wait times and health insurance bureaucracy for Wisconsin patients, while allowing clinicians to focus more time on patient care and less time on burdensome paperwork.
Insurer practices that detract from patient care and add more complexity to the health care system are facing increasing scrutiny as they have become a growing frustration for Wisconsin health care providers and patients. In addition to these concerns over prior authorization delays, WHA has increasingly been referring unscrupulous insurer practices to the Office of the Commissioner of Insurance, and has recently helped spur the introduction of state legislation to curb the growing practice of “white bagging,” a practice by insurance companies requiring that certain life-changing medications be shipped from a source that they dictate, rather than using the patient’s local hospital pharmacy.
So far, the Seniors' Time Access to Care Act of 2021 has been cosponsored by Reps. Moore, Grothman, Kind, Pocan, and Gallagher from Wisconsin's congressional delegation as well as 241 other members of the House of Representatives and five members of the U.S. Senate.
Contact WHA's Jon Hoelter with questions.

This story originally appeared in the November 18, 2021 edition of WHA Newsletter