APTA-Backed Bill Presses for Medicare Advantage Prior Authorization Reforms

The legislation would require MA plans to share data, provide transparency, create more efficient systems, and do a better job of listening.

APTA-supported bipartisan legislation taking aim at misuse of prior authorization in Medicare Advantage plans has arrived at the U.S. House of Representatives. If signed into law, the bill could mark a major shift in Medicare Advantage by holding plans more accountable for their use of prior authorization, establishing a pathway for "real time" coverage decisions, and requiring MA companies to get more input from providers and other stakeholders on what is and isn't deemed clinically appropriate.

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