Congress is considering two bipartisan proposals aimed at addressing different Medicare Advantage challenges: delays before care is delivered and payment reversals after care has already been approved.
The Improving Seniors’ Timely Access to Care Act (H.R. 3514/S. 1816) would establish additional requirements around Medicare Advantage prior authorization, including electronic processes, greater transparency and more standardized plan practices. The House Ways and Means Committee and House Energy and Commerce Committee both advanced the House legislation this summer. LeadingAge continues to support the legislation as part of its Medicare Advantage policy priorities.
A second bipartisan proposal, the Protecting Approved Care Act, focuses on what can happen after care has already been authorized. The legislation would generally prevent Medicare Advantage plans from retroactively denying coverage, reducing payment or downcoding claims after an approved service has been delivered, except in circumstances such as good cause or reliable evidence of fraud. The proposal also addresses prior authorization, concurrent review and authorizations for transfers from hospitals to post acute care settings.
Why it matters
For home health and other post acute providers, Medicare Advantage challenges do not always end once authorization is received. Delays in obtaining authorization can affect timely transitions to care, while later payment reductions or reversals can create additional administrative and financial burden after services have already been furnished.
Together, these proposals reflect continued congressional attention to both ends of the process: getting timely approval for needed care and providing greater certainty once that care has been approved and delivered.
What to do