Medical groups push CMS to finalize proposed prior authorization reforms
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The American Medical Association and 118 other medical societies, including the American College of Rheumatology, are urging CMS to finalize proposed rules aiming to reform prior authorization, according to a press release.
“Physicians appreciate the efforts of CMS to address the significant and multifaceted challenges that prior authorization requirements pose to Medicare beneficiaries and physicians,” AMA President Jack Resneck Jr, MD, said in a press release released by the association. “We applaud CMS for listening to physicians, patients, federal inspectors and many other stakeholders, and recognizing a vital need to rein in Medicare Advantage plans from placing excessive and unnecessary administrative obstacles between patients and evidence-based treatments.”
CMS announced the proposed changes in December. If approved, the rules would require providers to institute a Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard application programming interface, to facilitate the processing of electronic prior authorizations. Additionally, certain payers would be required to include rationale when denying requests, publish metrics related to prior authorization and respond to requests in a timely manner. The changes would require that urgent requests be processed within 72 hours, while standard requests be processed within 7 business days.
Eligible health care settings would also be able to add a new Electronic Prior Authorization measure via the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System.
According to CMS, the new rules would support higher quality patient care while requiring providers to navigate with fewer obstacles, but their true impact is not certain.
The rules are available to review online, and comments may be submitted through March 13.
In a Feb. 13 letter addressed to CMS Administrator Chiquita Brooks-LaSure, the societies urged for the finalization of the proposed rules, which “target the inappropriate use of authorization requirements by Medicare Advantage plans to delay, deny and disrupt the provision of medically necessary care to patients,” the release said. Read the full letter here.
The AMA noted a recent survey that said 93% of providers reported care delays caused by prior authorization approvals, and that Medicare Advantage plans denied about 13% of prior authorization requests, according to the release.
“Waiting on a health plan to authorize necessary medical treatment is too often a hazard to patient health,” Resneck said in the release. “To protect patient-centered care for the 28 million older Americans that rely on Medicare Advantage, physicians urge CMS to finalize the proposed policy changes and strengthen its prior authorization reform effort by extending its proposals to prescription drugs. We stand ready to continue our work with federal officials to remove obstacles and burdens that interfere with patient care.”
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