Gillibrand, Colleagues Reintroduce Bill to Improve Seniors’ Access to Health Care

Legislation Would Improve Access To Care For Many Of The Over Two Million New Yorkers Enrolled in Medicare Advantage Plans

U.S. Senator Kirsten Gillibrand joined a bipartisan group of senators in reintroducing the Improving Seniors’ Timely Access to Care Act, zero-cost legislation to improve access to care for seniors enrolled in Medicare Advantage (MA) plans. The bill focuses on streamlining the often cumbersome and time-consuming prior authorization process, allowing health care providers to spend more time on patient care rather than administrative burdens.

This legislation would help physicians better serve and improve care for the 32.8 million Americans – including the over two million New Yorkers– enrolled in an MA plan.

“Senior citizens have spent their entire lives contributing to our communities, and they deserve every resource to support their health and well-being,” said Senator Gillibrand.“The Improving Seniors’ Timely Access to Care Act will help cut through unnecessary red tape and ensure timely medical care is accessible to older Americans. Seniors should have reliable access to specialist care, mental health support, preventative services, and the treatments they need to live with dignity. I am proud to support this important legislation, and I pledge to continue fighting to expand access to quality, affordable, and timely health care for our seniors.” 

Prior authorization is a tool used by health plans to reduce unnecessary care by requiring health care providers to get pre-approval for medical services. However, the current system often results in multiple faxes or phone calls by clinicians, which takes precious time away from delivering care. Prior authorization continues to be the number one administrative burden identified by health care providers, and nearly three out of four Medicare Advantage enrollees are subject to unnecessary delays due to the practice.

The Improving Seniors’ Timely Access to Care Act would:

1. Establish an electronic prior authorization process for Medicare Advantage plans, including a standardization for transactions and clinical attachments.
2. Increase transparency around Medicare Advantage prior authorization requirements and their use.
3. Clarify HHS’ authority to establish timeframes for e-prior authorization requests, including expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.
4. Expand beneficiary protections to improve enrollee experiences and outcomes.
5. Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-prior authorization process.
6. Codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.
7. Result in zero cost to American taxpayers.

In addition to Senator Gillibrand, this legislation is cosponsored by U.S. Senators Mark Warner (D-VA), Roger Marshall (R-KS), Maggie Hassan (D-NH), John Fetterman (D-PA), Amy Klobuchar (D-MN), Bill Cassidy (R-LA),  Shelley Moore Capito (R-WV), John Hickenlooper (D-CO), James Lankford (R-OK), Jeff Merkley (D-OR), Marsha Blackburn (R-TN), Cynthia Lummis (R-WY), Cindy Hyde-Smith (R-MS), Tim Kaine (D-VA), Jeanne Shaheen (D-NH), Mike Rounds (R-SD), Alex Padilla (D-CA), Bill Hagerty (R-TN), Andy Kim (D-NJ), John Boozman (R-AR), Dick Durbin (D-IL), John Cornyn (R-TX), Patty Murray (D-WA), Jerry Moran (R-KS), Maria Cantwell (D-WA), Mazie Hirono (D-HI), Thom Tillis (R-NC), Cory Booker (D-NJ), Tina Smith (D-MN), Peter Welch (D-VT), Sheldon Whitehouse (D-RI), Ted Budd (R-NC), Catherine Cortez Masto (D-NV), Tim Sheehy (R-MT), Tammy Baldwin (D-WI), Pete Ricketts (R-NE), Richard Blumenthal (D-CT), Elizabeth Warren (D-MA), Tammy Duckworth (D-IL), John Hoeven (R-ND), Rick Scott (R-FL), Mark Kelly (D-AZ), Jacky Rosen (D-NV), Martin Heinrich (D-NM), Deb Fischer (R-NE), and Chris Coons (D-DE).

Companion legislation was also introduced in the U.S. House of Representatives by Reps. John Joyce, M.D. (R-PA-13), Mike Kelly (R-PA-16), Suzan DelBene (D-WA-01), and Ami Bera, M.D. (D-CA-06).

This legislation is endorsed by 140 health care organizations.

The full text of the legislation can be found here.

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