Bill Introduced in Congress to Limit Medicare Advantage Prior Authorization

On May 21, 2021, House Bill 3173 (117th Congress), which seeks to cut red tape on prior authorizations in Medicare was introduced. The bill would require Medicare Advantage plans to report approval and denial rates. The bill was introduced by Representative Larry Buchon, MD, and would require Medicare Advantage insurers to be more clear about their prior authorization policies, according to a group of House members.

H.R.3173 would establish an electronic prior authorization process and would require the Department of Health and Human Services to create a process for real-time decisions for items and services routinely approved. It would require Medicare Advantage plans to report on their use of prior authorization and their rate of approvals and denials and would encourage plans to adopt prior authorization programs that adhere to evidence-based medical guidelines.

The bill has also received the support of more than 70 leading health care provider and patient advocacy organizations and has 280 congressional cosponsors.

The legislation will now be assigned to a House committee. Some of the co-sponsors are members of the House Ways and Means Committee and have indicated they are working to have the bill assigned to that committee. Sponsors have also indicated there will be a companion bill forthcoming in the Senate as well.