{"id":244,"date":"2026-06-10T17:00:18","date_gmt":"2026-06-10T17:00:18","guid":{"rendered":"https:\/\/americanindustryreview.com\/?p=244"},"modified":"2026-06-10T17:00:18","modified_gmt":"2026-06-10T17:00:18","slug":"prior-authorization-bill-now-eligible-for-house-fast-track","status":"publish","type":"post","link":"https:\/\/americanindustryreview.com\/?p=244","title":{"rendered":"Prior authorization bill now eligible for House fast track"},"content":{"rendered":"
\n

Legislation aimed at reducing delays when\u00a0Medicare Advantage plans require preapproval for care could hit the House floor under fast-track rules for bills that have broad support.<\/p>\n

Read more Unhappy independents will decide this election<\/a><\/p>\n

The bill, sponsored by Rep. Mike Kelly, R-Pa., targets use of prior authorization in Medicare Advantage \u2014 in which insurers approve or deny services before they can be delivered.<\/p>\n

The legislation would require insurers\u2019 plans to adopt electronic\u00a0systems that use standardized transactions, which proponents say will\u00a0reduce delays caused when health care providers are forced to\u00a0navigate\u00a0through various payer portals or send information by fax. It would also require plans to submit a range of data to the federal government, including which services are subject to\u00a0prior authorization requirements and the percentage and number of requests approved and denied.<\/p>\n

The use of prior authorization has become widely loathed by the public and health care providers, who say it delays access to needed care. Insurers defend\u00a0the practice as necessary to prevent patients from receiving unnecessary care. Its use\u00a0has been scrutinized in Medicare Advantage, the private option\u00a0that now covers more than half of Medicare beneficiaries.<\/p>\n

Known as the \u201cImproving Seniors\u2019 Timely Access to Care Act,\u201d the bill has 290 co-sponsors, making it eligible for the consensus calendar, which allows legislation to move outside of the traditional committee process.<\/p>\n

A sponsor of the legislation would have to make a motion to the House clerk to place the measure on the calendar.<\/p>\n

Bill sponsors are waiting for details on next steps before filing the motion, according to a source familiar with the situation. That could include a markup by the House Ways and Means Committee, a step that\u2019s not strictly necessary\u00a0but can be done out of deference to the committee with jurisdiction.<\/p>\n

A Ways and Means Committee spokesperson said the panel does not comment on specific hearings or markups until they are officially noticed.<\/p>\n

The bill reached the 290 co-sponsors threshold Monday with support from Reps. Nancy Mace, R-S.C., and George Whitesides, D-Calif. A companion measure in the Senate, sponsored by\u00a0Roger Marshall, R-Kan., has 70 co-sponsors.<\/p>\n

\u2018Defining moment\u2019<\/h2>\n

Despite the bipartisan support, lawmakers, advocates and lobbyists have been frustrated with the slow pace of getting the legislation across the finish line. It was first introduced in 2019 by Rep. Suzan DelBene, D-Wash., who co-sponsors the current bill.<\/p>\n

Kelly and DelBene, along with cosponsors Reps. Ami Bera, D-Calif., and John Joyce, R-Pa., said in a joint statement Wednesday that the bill has now reached a \u201cdefining moment,\u201d\u00a0and that passage would \u201cmake it much easier for seniors to receive the care they\u2019re entitled to while also alleviating unnecessary burdens on physicians and hospitals.\u201d<\/p>\n

For several sessions of Congress, the measure has been one of the most popular in the House and Senate. It has no public opposition and, according to scores from the Congressional Budget Office, would come at no\u00a0cost to the government.<\/p>\n

The reason behind the holdup is unclear even to the bill\u2019s sponsors and supporters, other than a Congress perennially distracted by other priorities like government funding, reconciliation bills and other fights.<\/p>\n

The legislation is publicly supported by a coalition of Medicare Advantage insurers called the Better Medicare Alliance, as well as by insurer Humana, patient groups and provider groups.\u00a0\u00a0<\/p>\n

Read more Rush to regulate AI divides Democrats in Congress<\/a><\/p>\n

\u201cThere\u2019s no good reason, there\u2019s no weird political opposition or anybody trying to hold this back, it\u2019s just finding the path to do it,\u201d said Peggy Tighe, lead legislative counsel for the Regulatory Relief Coalition, a group of national physician specialty organizations formed to advocate on this issue.<\/p>\n

After the measure reached the threshold for the consensus calendar in 2022, the Ways and Means Committee moved quickly to advance it. The House ultimately passed the legislation by voice vote.\u00a0But it died in the Senate over concerns about a $16 billion cost estimate.\u00a0<\/p>\n

Efforts to include the bill in previous year-end packages did not pan out amid competing priorities.<\/p>\n

The Biden administration then\u00a0implemented similar policies, and although some provisions haven\u2019t yet taken effect,\u00a0the CBO has acknowledged them and lowered the cost score to zero dollars in 2024.<\/p>\n

\u201cThe seniors\u2019 timely act should be a slam dunk,\u201d said Scott Styles, executive director of the newly launched Alliance for Medicare, which is aimed at improving Medicare Advantage. \u201cIt\u2019s hard to really understand why that hasn\u2019t moved.\u201d<\/p>\n

Pervasive requirements<\/h2>\n

According to health policy research organization KFF,\u00a099 percent of Medicare Advantage enrollees are subject to prior authorization for some services, mostly higher-cost ones like inpatient hospital stays.<\/p>\n

In 2024, 53 million prior authorization requests were submitted to Medicare Advantage insurers, according to the KFF analysis. That year, 7.7 percent of requests were denied. Of the 11 percent of denials that were appealed, 81 percent were partially or fully overturned.<\/p>\n

Advocates say the high overturn rate points to flaws in the process\u00a0and note that the data required under the bill could help shed light on the problem.<\/p>\n

The Trump administration is also proposing action on prior authorization.<\/p>\n

The Centers for Medicare and Medicaid Services recently proposed rules that would require Medicare Advantage use electronic prior authorization for prescription drugs. It sets deadlines of seven calendar days for \u201cstandard\u201d\u00a0prior authorization requests and 72 hours for expedited ones.<\/p>\n

The rules apply to Medicare Advantage, Medicaid, the Children\u2019s Health Insurance Program, and individual and small group insurers on federally facilitated exchanges.<\/p>\n

The rule is similar to the Biden administration rule finalized in 2024 that applied to nondrug services.<\/p>\n

The Trump administration has also touted \u201cvoluntary\u201d agreements it has reached with insurance companies to streamline the process. America\u2019s Health Insurance Plans, a trade group for health insurers, says health plans have eliminated 11 percent of prior authorizations across a range of medical services.<\/p>\n

But physicians say they haven\u2019t seen those changes in practice yet.<\/p>\n

\u201cPhysician trust in voluntary insurer pledges is deeply eroded after years of unfulfilled promises,\u201d American Medical Association President Bobby Mukkamala said in a statement last month.\u00a0<\/p>\n

Read more \u2018Anti-weaponization\u2019 fund challengers question its demise<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Legislation aimed at reducing delays when Medicare Advantage plans require preapproval for care could hit the House floor under fast-track rules for bills that have broad support. The bill, sponsored by Rep. Mike Kelly, R-Pa., targets use of prior authorization in Medicare Advantage \u2014 in which insurers approve or deny services before they can be delivered. […]<\/p>\n","protected":false},"author":1,"featured_media":243,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-244","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-policy"],"yoast_head":"\nPrior authorization bill now eligible for House fast track - American Industry Review<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/americanindustryreview.com\/?p=244\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Prior authorization bill now eligible for House fast track - American Industry Review\" \/>\n<meta property=\"og:description\" content=\"Legislation aimed at reducing delays when Medicare Advantage plans require preapproval for care could hit the House floor under fast-track rules for bills that have broad support. 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