Improving Access to Care Act (HR 3514)

Direct Link: https://www.govinfo.gov/app/details/BILLS-119hr3514ih

Introduction

This bill aims to improve access to care for Medicare Advantage enrollees, particularly in rural and low-income communities.

Main Provisions

Real-Time Decisions: The Secretary may establish timeframes for responses to prior authorization requests, including 24 hours for expedited determinations, real-time decisions for routinely approved items and services, and other prior authorization requests.

Timely Responses for All Prior Authorization Requests

Section 1852(g) of the Social Security Act (42 U.S.C. 1395w–1g) is amended to require timely responses for all prior authorization requests submitted under part C, including:

a request for expedited determination described in paragraph (3)(A);
a real-time decision for routinely approved items and services; and
any other prior authorization request.

Improving Timeliness of Responses

The Secretary may establish, for purposes of an organization determination made with respect to a prior authorization request for an item or service to be furnished to an individual:

Timeframes, such as 24 hours, for the organization to notify the enrollee (and the physician involved, as appropriate) of such determination.

Benefits and Impacts

This bill aims to improve access to care by reducing health disparities for Medicare Advantage enrollees in rural and low-income communities, producing operational efficiencies for providers and suppliers, and improving enrollee access to benefits under this part.