Members of Congress urge CMS to further streamline prior authorization

A bipartisan group of 233 representatives and 61 senators called on the Centers for Medicare & Medicaid Service to enhance its proposal to streamline prior authorization processes in Medicare Advantage, Medicaid and the federally-facilitated Marketplace to require real-time electronic decision-making for routinely approved services, responses for emergency procedures within 24 hours and additional transparency. They said adding these provisions would better align the rule with the Improving Seniors’ Timely Access to Care Act, House-passed legislation supported by the AHA to streamline prior authorization in the MA program, and urged CMS to quickly finalize the rule with these updates.

AHA also has urged CMS to quickly finalize the proposed rule, adequately enforce and monitor the requirements and test and vet any electronic standards before mandating their adoption.