Vol. 66, Issue 37
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IN THIS ISSUE
- AHA: 2022 Will Be the Most Financially Difficult for Hospitals and Health Systems Since the Start of Pandemic
- Only Two Weeks Until the 2022 WHA Workforce Forum – Register Today
- WHA Invites Community Benefits Stories for 2022 Report
- Upcoming EMResource Reporting Changes: DHS/WHA Webinar
- WHA-Supported Bill to Improve Medicare Advantage Prior Authorization Clears U.S. House of Representatives
- WHA Expresses Concerns Over Inadequate Payment Update in Outpatient Rule
- GUEST COLUMN: Impacting Workers’ Compensation with Worksite Benefits
EDUCATION EVENTS
Apr. 9, 2025
2025 Advocacy DayApr. 22, 2025
Nursing ServicesMay. 14, 2025
2025 WHA Workforce ForumClick here to view quality event calendar
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Thursday, September 15, 2022
WHA-Supported Bill to Improve Medicare Advantage Prior Authorization Clears U.S. House of Representatives
On Sept. 14, the United States House of Representatives passed the Improving Seniors' Timely Access to Care Act on a unanimous voice vote.
This legislation, which is supported by WHA and the American Hospital Association, would establish various standardization and transparency requirements for the prior authorization practices of health insurers offering Medicare Advantage Plans. Among other things, it would require these plans to:
The legislation, which included 323 House members cosponsoring it, including Reps. Moore, Grothman, Pocan, Kind and Gallagher from Wisconsin, also has 42 cosponsors in the Senate. Even with this significant level of support, it is unclear if or when the Senate will take the legislation up, though some have speculated it could be included in a year-end omnibus package.
The Congressional Budget Office estimated the bill would add $16 billion in costs over a 10-year period. Its estimate is based on the premise that the reforms in the bill would lead to a greater utilization of Medicare services by Medicare beneficiaries.
Contact WHA Vice President of Federal and State Relations Jon Hoelter with questions.
This legislation, which is supported by WHA and the American Hospital Association, would establish various standardization and transparency requirements for the prior authorization practices of health insurers offering Medicare Advantage Plans. Among other things, it would require these plans to:
- Establish an electronic prior authorization program to provide real-time decisions in response to requests for items and services that are routinely approved,
- Annually publish transparency information such as the percentage of requests approved and the average response time, and
- Create quality and timeliness standards for prior authorization determinations.
The legislation, which included 323 House members cosponsoring it, including Reps. Moore, Grothman, Pocan, Kind and Gallagher from Wisconsin, also has 42 cosponsors in the Senate. Even with this significant level of support, it is unclear if or when the Senate will take the legislation up, though some have speculated it could be included in a year-end omnibus package.
The Congressional Budget Office estimated the bill would add $16 billion in costs over a 10-year period. Its estimate is based on the premise that the reforms in the bill would lead to a greater utilization of Medicare services by Medicare beneficiaries.
Contact WHA Vice President of Federal and State Relations Jon Hoelter with questions.