AHA Statement on CMS Prior Authorization Rule

Ashley Thompson
Senior Vice President, Public Policy Analysis and Development
American Hospital Association

December 11, 2020

Hospitals and health systems appreciate CMS taking action to remove inappropriate barriers to patient care by streamlining the prior authorization processes for some health plans. While prior authorization can be a helpful tool for ensuring patients receive appropriate care, the practice is too often used in a manner that leads to dangerous delays in treatment, clinician burnout and more waste in the health care system. The proposed rule is a welcome step toward helping clinicians spend their limited time on patient care.

We are deeply disappointed, however, that CMS chose not to include Medicare Advantage plans, many of which have implemented abusive prior authorization practices, as documented in our recent report. We urge the agency to reconsider and hold Medicare Advantage plans accountable to the same standards.