AHA urges CMS to finalize prior authorization rule

AHA today urged the Centers for Medicare & Medicaid Services to quickly finalize a proposed rule that would require Medicare Advantage, Medicaid and federally-facilitated Marketplace plans to streamline their prior authorization processes, but urged the agency to adequately enforce and monitor the requirements and test and vet any electronic standards before mandating their adoption.

“The proposed rule is a welcome step toward helping patients get timely access to care and clinicians focus their limited time on patient care rather than paperwork,” AHA wrote. “However, to truly realize these benefits, we urge CMS to ensure a baseline level of enforcement and oversight. In addition, while hospitals and health systems appreciate CMS’ effort to improve the electronic exchange of care data to reduce provider burden and streamline prior authorization processes, we urge CMS to ensure that any electronic standards are adequately tested and vetted prior to mandated adoption.”