U.S. Senator Cindy Hyde-Smith (R-Miss.) has co-sponsored bipartisan legislation allowing Medicare beneficiaries to receive care more quickly and reducing administrative burdens on healthcare providers.

The Improving Seniors’ Timely Access to Care Act (S.4532), introduced by U.S. Senator Roger Marshall, M.D. (R-Kan.), seeks to streamline the prior authorization process under Medicare Advantage (MA) to ensure patients can access medical services promptly. Healthcare providers have identified prior authorization requirements as a significant source of administrative burden.

“Streamlining the paperwork burden, which this bill aims to do, would benefit seniors with Medicare Advantage coverage who need timely access to care and the health care providers overwhelmed by paperwork demands. The current system is unfair to both and should be improved, posthaste,” Hyde-Smith said.

MA prior authorization is a tool used by health plans that require providers to obtain pre-approval for medical services. This process often leads to communication lapses between clinicians and insurance companies, resulting in longer patient wait times.

The bill proposes several measures to address these issues:

• Establishing an electronic prior authorization process for MA plans, including standardization for transactions and clinical attachments.
• Increasing transparency around MA prior authorization requirements and their use.
• Clarifying the Centers for Medicare and Medicaid Services’ authority to establish timeframes for electronic prior authorization requests, including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
• Expanding beneficiary protections to improve enrollee experiences and outcomes.
• Requiring the U.S. Department of Health and Human Services and other agencies to report to Congress on program integrity efforts and different ways to improve the electronic prior authorization process further.

Healthcare professionals in Mississippi and across the nation have experienced increased burnout following the COVID-19 pandemic, with high administrative burdens being a direct contributing factor, according to a 2022 U.S. Surgeon General report.

The Mississippi State Medical Association, Mississippi Oncology Society, and Mississippi Academy of Eye Physicians and Surgeons are among nearly 400 national, regional, state, and district organizations that have endorsed the bill.