Bill Overview
Title: Improving Seniors’ Timely Access to Care Act of 2022
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: Seniors using Medicare Advantage plans
Estimated Size: 30000000
- The bill impacts Medicare Advantage (MA) plans, which serve a significant portion of the senior population in the United States.
- Medicare Advantage covers around 50% of all eligible Medicare beneficiaries, equating to about 30 million people in the United States.
- Globally, the bill specifically targets people covered by Medicare Advantage, which is a US-specific program; therefore, the global impact is essentially the same as the US impact.
Reasoning
- The policy primarily affects seniors enrolled in Medicare Advantage (MA) plans as it targets improving access to care by streamlining prior authorization processes.
- This legislative change is anticipated to impact the quality and speed of healthcare services available to seniors, potentially altering their wellbeing over time.
- The policy is constrained by a specific budget, which limits the scope and robustness of implementation in initial years.
- To assess self-reported wellbeing, interviews with a variety of individuals representative of the seniors on MA plans have been simulated.
Simulated Interviews
retired teacher (Florida)
Age: 70 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- I'm hopeful about the new policy speeding up the approval of my treatments, but I'm skeptical about how fast these changes will occur.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
retired engineer (Texas)
Age: 75 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 10/20
Statement of Opinion:
- The policy sounds good, but real-time decisions on prior authorizations need to be reliable. I don't want it just for show.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 9 | 4 |
retired nurse (California)
Age: 68 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 5.0 years
Commonness: 18/20
Statement of Opinion:
- I see this as a great step for seniors, especially if it improves transparency and accountability in the MA plans.
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 | 9 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
retired lawyer (New York)
Age: 80 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 14/20
Statement of Opinion:
- If the policy can reduce bureaucracy, I'd be a lot happier with my healthcare. My time is precious.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
retired artist (Ohio)
Age: 85 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 17/20
Statement of Opinion:
- Improving the speed of response is vital, but I worry if smaller providers can keep up with the tech requirements.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
retired factory worker (Illinois)
Age: 72 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- I hope this policy will help with the endless paperwork and waiting times. It feels like my health is always on hold.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
retired librarian (Washington)
Age: 78 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 13/20
Statement of Opinion:
- It seems like a necessary change, but I wonder if it can adapt fast enough for seniors with urgent needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 5 |
retired postal worker (Georgia)
Age: 76 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 16/20
Statement of Opinion:
- I'm hopeful this will modernize healthcare for us old folks, but these things never roll out how they promise.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 5 |
retired homemaker (Michigan)
Age: 83 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- Rural areas often get left out. I hope this doesn't become another policy that only helps the city folks.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 4 |
| Year 2 | 4 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
retired military (Arizona)
Age: 69 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 12/20
Statement of Opinion:
- Speedy authorizations would help as I travel often and need my prescriptions sorted wherever I am.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 5 |
| Year 20 | 9 | 5 |
Cost Estimates
Year 1: $50000000 (Low: $30000000, High: $70000000)
Year 2: $45000000 (Low: $25000000, High: $65000000)
Year 3: $40000000 (Low: $20000000, High: $60000000)
Year 5: $35000000 (Low: $20000000, High: $50000000)
Year 10: $30000000 (Low: $15000000, High: $45000000)
Year 100: $10000000 (Low: $5000000, High: $20000000)
Key Considerations
- The potential for initial high implementation costs of electronic systems balanced against long-term savings from streamlined processes.
- The variability in cost estimates arises from differences in the readiness of MA plans to adopt electronic systems and publish necessary data.
- Potential opposition or support from stakeholders such as healthcare providers, patients, and insurers based on perceived impacts on their operations and care provision.