Lawmakers want CMS' prior authorization proposal to go further

More than 230 U.S. representatives and 61 senators are asking HHS and CMS leaders to bolster a proposed rule aimed at streamlining the prior authorization process, Politico reported June 21. 

A letter sent to the leaders was spearheaded by Washington Rep. Suzan DelBene, who was one of the sponsors of a bill in 2022 that attempted to reform the Medicare Advantage prior authorization process. The bill passed the House but died in the Senate over concerns about its projected $16 billion cost, according to the report. 

Ms. DelBene told Politico that the rule CMS proposed in December makes "huge strides forward for seniors," but "we think it needs to go further." 

The lawmakers are asking CMS to add provisions to the proposed rule to align more with the legislation that passed the House last year, according to the report. 

The provisions include:

  • Real-time prior authorization for routine matters.
  • A 24-hour deadline for Medicare Advantage plans to answer prior authorization requests for urgently needed care. 
  • More detailed transparency metrics. 

CMS set a December 2025 deadline to finalize the rule, but the agency said it will publish it sooner if possible, according to the report. 

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