AMA, provider groups praise CMS' proposed MA prior authorization changes

Provider groups are applauding CMS' proposed rule overhauling prior authorization in Medicare Advantage. 

A group of 118 medical societies, led by the American Medical Association, voiced strong support for the reforms in a comment letter submitted to CMS Feb. 13. 

"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," AMA President Jack Resneck Jr., MD, said in a news release

The American Hospital Association also submitted comments praising the rule, particularly its prior authorization requirements. 

"We believe the proposed changes will go a long way in ensuring that Medicare beneficiaries have equal access to medically necessary care and consumer protections and that those enrolled in MA will not continue to be unfairly subjected to more restrictive rules and requirements," the association wrote. 

The AHA urged the rules, if implemented, be rigorously enforced. 

The proposed rule, introduced in December, includes several proposed changes to Medicare Advantage, including requiring an approved prior authorization request to remain valid for a member's entire course of treatment and requiring coverage determination to be reviewed by relevant professionals. 

Medicare Advantage plans, on average, deny 6 percent of prior authorization requests, according to Kaiser Family Foundation. 

The rule also proposed stricter marketing standards for MA plans, changes to the star ratings program, new behavioral health network requirements and additional subsidies for Part D members. 

In its comment letter, AHIP, the trade association representing the insurance industry, expressed concerns with other provisions in the rule but said it is broadly supportive of the prior authorization changes. 

In its comments, AHIP wrote it supports efforts "clarifying the scope of permissible PA," but had some reservations with the details of the proposal. 

"We urge CMS to retain long-permitted flexibilities in the MA program so plans can encourage the delivery of high-quality care in safe, cost-effective alternative settings that are covered in the original Medicare program. We also are concerned about the feasibility of implementing new restrictions and process mandates for 2024 given MA bid cycle and operational needs." 

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