Congressman Higgins Announces Approval of the Improving Seniors' Timely Access to Care Act

Press Release

Congressman Brian Higgins (NY-26) announced the approval of the Improving Seniors' Timely Access to Care Act (H.R.8487). Cosponsored by Higgins, the bill establishes an electronic prior authorization program that will improve access to care for seniors.

"Too often, doctors and patients get bogged down in the process of getting necessary care approved by insurance companies. This results in patients foregoing care, which is unacceptable," said Congressman Higgins. "This legislation is welcome because it removes some barriers to care, and allows physicians to spend more time with patients than processing paperwork with insurance companies. Ultimately, it will save lives and improve healthcare outcomes for Western New York seniors."

Medicare allows insurance companies to competitively bid on a yearly basis to provide coverage to seniors - called Medicare Advantage. As part of their offerings, some insurance companies require physicians and patients to obtain prior authorization for medical treatments or tests before they can be administered. The process is often very frustrating, and frequently involves multiple phone calls and between doctors' offices and insurance companies, faxing documents, and a significant amount of time that physicians could otherwise spend with their patients.

One in four physicians report that the current prior authorization process had led to a patient being hospitalized. On average, doctors are spending 13 hours per week completing prior authorization paperwork.

This legislation will establish an electronic authorization process, eliminating the need to fax medical documentation. The bill also requires the U.S. Department of Health and Human Services to create a process for "real time decisions" to approve routine medical services and items more efficiently.

Additionally, this measure will encourage insurance plans to have prior authorization policies that adhere to evidence-based medical guidelines in consultation with physicians. Ultimately, the bill will improve transparency by requiring plans to provide reports on their use of prior authorization, as well as their rate of approvals and denials to the Centers for Medicare and Medicaid Services (CMS).

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