Bill Overview
Title: Improving Seniors’ Timely Access to Care Act of 2021
Description: 2022 This bill establishes several requirements and standards relating to prior authorization processes under Medicare Advantage (MA) plans. Specifically, MA plans must (1) establish an electronic prior authorization program that meets specified standards, including the ability to provide real-time decisions in response to requests for items and services that are routinely approved; (2) annually publish specified prior authorization information, including the percentage of requests approved and the average response time; and (3) meet other standards, as set by the Centers for Medicare & Medicaid Services, relating to the quality and timeliness of prior authorization determinations.
Sponsors: Rep. DelBene, Suzan K. [D-WA-1]
Target Audience
Population: People enrolled in Medicare Advantage (MA) plans
Estimated Size: 27000000
- The bill impacts individuals who are enrolled in Medicare Advantage (MA) plans.
- Medicare Advantage plans are available to people age 65 and older, as well as to some younger individuals with disabilities or certain health conditions.
- The key improvement is in the speed and transparency of the prior authorization process, which aims to reduce delays in accessing health care services for this population.
Reasoning
- The primary group impacted by this policy are seniors aged 65 and older, and some younger individuals with disabilities who are enrolled in Medicare Advantage plans.
- The main benefit of the policy is the reduction in waiting times for prior authorization, potentially enhancing timely access to necessary treatments.
- The budget constraints suggest a limitation on the extent to which electronic systems can be implemented and maintained, possibly affecting smaller or more geographically isolated service providers.
- Not all enrollees will be directly impacted at the same time since not all require frequent prior authorizations.
- Many seniors appreciate improvements in health care processes, particularly if they directly reduce bureaucratic hurdles and stress.
Simulated Interviews
retired teacher (Ohio)
Age: 70 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Having quicker access to authorizations would be wonderful. Sometimes, waiting for approval feels like forever, especially when you need care urgently.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 5 |
part-time consultant (Florida)
Age: 68 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- The delays in getting approvals have always been a frustration, so anything that speeds this up is beneficial.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 6 | 3 |
retired nurse (California)
Age: 72 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 7.0 years
Commonness: 10/20
Statement of Opinion:
- Improved speed of authorizations will definitely improve how quickly I can manage health issues. Usually, I have to wait too long to get the approvals.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 5 |
| Year 20 | 7 | 5 |
retired engineer (Texas)
Age: 75 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 9/20
Statement of Opinion:
- Any improvement is welcome, though I'm skeptical about real-time decisions. We'll see how well they implement it.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 4 |
artist (New York)
Age: 64 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- I think it'll be particularly useful for people who need frequent changes to their treatment plans.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
retired farmer (Illinois)
Age: 83 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I've faced many delays before, so an enhancement in processing times could mean a lot. However, I'm not sure how much it'll help with rare treatments.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
retired librarian (North Carolina)
Age: 69 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Reducing paperwork and speeding up processes can only help; I'm looking forward to seeing how efficient it becomes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
retired accountant (Pennsylvania)
Age: 80 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 11/20
Statement of Opinion:
- I'm happy with my current situation, so I hope it doesn't complicate the processes I'm used to.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 7 |
retired military officer (Arizona)
Age: 74 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 6.0 years
Commonness: 8/20
Statement of Opinion:
- Any easing in bureaucracy would be viewed positively on my part as it often impedes timely treatment.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 4 |
| Year 20 | 5 | 3 |
retired gardener (Oregon)
Age: 85 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 5/20
Statement of Opinion:
- Using electronic prior authorizations is a big step forward but I worry about navigating new technology.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 4 |
Cost Estimates
Year 1: $100000000 (Low: $80000000, High: $120000000)
Year 2: $50000000 (Low: $40000000, High: $90000000)
Year 3: $50000000 (Low: $40000000, High: $90000000)
Year 5: $50000000 (Low: $40000000, High: $90000000)
Year 10: $60000000 (Low: $50000000, High: $100000000)
Year 100: $70000000 (Low: $60000000, High: $120000000)
Key Considerations
- There are significant one-time implementation costs associated with setting up electronic systems.
- Potential for reduced costs long term due to improved health outcomes and efficiency gains.
- The bill aligns with broader healthcare digitalization trends, supporting electronic health records (EHR) integration.