Advocacy & Practice Updates — Advocacy & Practice
CMS Releases Electronic Prior Authorization Proposed Rule; May Spur Passage of Prior Authorization Bill This Year
On December 6, CMS released a proposed rule requiring Medicare Advantage (MA) plans and other public payers to implement standardized, electronic prior authorization processes. While not eliminating prior authorization, this proposed rule would mandate that payers develop the electronic process that ASRS and others in the medical community have long recommended.
In addition, the release of this proposed rule is seen as a boost for bipartisan legislation to ease the burden of prior authorization, the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). The bill passed the House unanimously earlier this year, but has been hampered by an unexpectedly high cost estimate from the Congressional Budget Office (CBO) of $16 billion over 10 years. The release of this proposed regulation could prompt the CBO to revise its estimate downward since the bill includes a requirement for an electronic prior authorization system that would now not be necessary.
ASRS and the medical community have argued that CMS already has the authority to implement all the provisions of the bill, but will continue to press for final passage of the bill by year’s end.
(Published 12.7.22)