4 reactions to CMS' prior authorization improvement proposal

CMS' Dec. 6 proposal to improve the prior authorization process was met positively from groups ranging from America's Health Insurance Plans to the Medical Group Management Association. 

Here is what four groups said about CMS' proposed rule:

America's Health Insurance Plans: AHIP's Fast PATH demonstration showed that electronic processes for prior authorization are essential for ensuring that patients receive swift, evidence-based care that improves value and reduces administrative burdens for everyone. This proposed rule would require clinicians and hospitals to adopt electronic prior authorization to meet certain quality measures, ensuring that we are all incentivized to work together for a better patient and clinician experience that improves satisfaction, efficiency, and affordability for everyone.

Protecting patient privacy is paramount. It is important to note that a gap remains in our nation's privacy framework. Personal health information shared with entities that are not required to comply with HIPAA will not be as robustly protected as other health care data. We strongly recommend that CMS work with Congress to address this gap.

American Hospital Association: The AHA commends CMS for taking important steps to remove inappropriate barriers to patient care by streamlining the prior authorization process for some health insurance plans. Hospitals and health systems especially appreciate that CMS included Medicare Advantage plans in these requirements, as the AHA has urged. Prior authorization is often used in a manner that results in dangerous delays in care for patients, burdens health care providers and adds unnecessary costs to the health care system.

The AHA looks forward to carefully reviewing the proposed rule, and we continue to urge the Senate to pass the Improving Seniors' Timely Access to Care Act to codify these protections in law.

Better Medicare Alliance: Better Medicare Alliance thanks CMS for their leadership in modernizing the prior authorization process for beneficiaries. While we continue to review the proposed rule in closer detail, we believe it complements our goals of protecting prior authorization's essential function in coordinating safe, effective, high-value care while also building on the Medicare Advantage community’s work streamlining this clinical tool to better serve its 30 million diverse enrollees. We additionally welcome the proposed rule's data exchange provisions, which will further improve communication between health plans, providers, and beneficiaries. Notably, the proposed rule addresses recent concerns from some lawmakers related to the budgetary impact of the BMA-endorsed Improving Seniors' Timely Access to Care Act, legislation that already passed the U.S. House of Representatives with unanimous support. 

Medical Group Management Association: MGMA is encouraged to see that CMS heeded our call to include Medicare Advantage plans in the scope of this proposed rule. An alarming number of medical groups report completing prior authorization requests via paper forms, over the phone, or through varying proprietary online payer portals. The onerous methods of completing these requests, coupled with the increasing volume is unsustainable. An electronic prior authorization program, if implemented appropriately, has the potential to alleviate administrative burden and allow practices to reinvest resources in patient care. This is a positive step forward for both medical groups and the patients they treat. We look forward to working with CMS to refine and finalize this rule.

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