Hospitals urge CMS to move ahead with Trump-era prior authorization rule
The American Hospital Affiliation is urging the Well being and Human Companies Division to revise and reissue a previous authorization rule proposed within the last days of the Trump administration.
The rule in query would streamline the documentation course of, cut back the period of time some insurers have to reply to prior authorization requests and require they construct applications to obtain these requests.
However the Biden administration froze implementation of the rule and others proposed by the earlier administration and hasn’t indicated but if it can transfer ahead with the proposal.
In a letter to Chiquita Brooks-LaSure, administrator of the Facilities for Medicare and Medicaid Companies, AHA President Stacey Hughes urged the company to finalize the rule with some adjustments, citing “administrative and scientific difficulties brought on by inefficient prior authorization processes.”
Underneath the rule, Medicaid and CHIP fee-for-service and managed care plans and entities must reply to prior authorization requests inside no later than 72 hours of receiving a request for expedited selections and not more than seven days for traditional selections.
AHA argued the rule must be revised to require prior authorization responses inside 72 hours for traditional companies and inside 24 hours for pressing companies.
The proposed rule additionally excludes Medicare Benefit plans from the adjustments, which Hughes stated is “extraordinarily troubling” and would “considerably cut back the potential affect of the regulation.”
About one-third of Medicare beneficiaries are in MA plans. Presently, MA plans can take as much as 14 days to reply to a previous authorization request.
“With a purpose to promote procedural enhancements and stop damaging well being outcomes related to delays in look after all beneficiaries, we urge CMS to require MAOs to stick to the necessities set forth on this proposal,” Hughes wrote. “Together with them additionally would scale back administrative burdens and prices as suppliers would have much less variation amongst well being plans.”
Hughes additionally urged CMS to require MA plans “contemplate a service licensed” when a supplier has a historical past of prior authorization approval of 90% or higher.
Insurers blasted the rule when the Trump administration proposed it in December, with America’s Well being Insurance coverage Plans President and CEO Matt Eyles primarily taking issue with the know-how necessities.
Congress has additionally proven curiosity within the subject, with teams of bipartisan senators and Home members introducing bills that might streamline prior authorization in MA plans.
The Senate invoice, sponsored by Sens. Roger Marshall (R-Kan.), Krysten Sinema (D-Ariz.) and John Thune (R-S.D.), would require Medicare Benefit plans set up digital prior authorization applications and subject real-time selections for companies that routinely get permitted.