Washington E-Newsletter

AANS and CNS Continue Advocating for Prior Authorization Reform

Last year, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule requiring Medicare Advantage plans and other public health insurers to implement automated prior authorization systems. This proposal would:

  • Require insurers to adopt electronic prior authorization;
  • Reduce care delays and improve patient outcomes by ensuring that health plans respond to prior authorization requests within specific timeframes (72 hours for urgent requests and seven days for standard requests);
  • Require coverage determinations to be reviewed by professionals with relevant expertise;
  • Support efforts (e.g., gold cards) to waive or modify prior authorization requirements based on provider performance; and
  • Compel health plans to publicly report the use of prior authorization, including information on delays and denials.

The proposal has cleared CMS and awaits final approval from the White House. This proposed rule mirrors the key policies of the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018 in the 117th Congress), which unanimously passed the House of Representatives and garnered 380 combined bipartisan co-sponsors. The AANS and the CNS hope the proposal will be finalized before the end of the year.

On the legislative front, the AANS and the CNS recently joined the Regulatory Relief Coalition (RRC) in sending a letter thanking Reps. Brett Guthrie (R-Ky.) and Anna Eshoo (D-Calif.) for including the Seniors’ Timely Access to Care Act at the recent House Committee on Energy and Commerce health care hearing. Following the hearing, on Oct. 19, the RRC issued a press release featuring AANS/CNS Washington Committee chair Russell R. Lonser, MD, FAANS, who stated “America’s neurosurgeons urge CMS to release final rules to streamline prior authorization and for Congress to get this legislation across the finish line this year because patients can ill afford to wait any longer to hold Medicare Advantage plans accountable.”

Finally, as previously reported, on July 26, the House Ways and Means Committee advanced legislation — the Health Care Transparency Act (H.R.4822) — to reform prior authorization in the Medicare Advantage (MA) program. The bill included the neurosurgery-backed Improving Seniors’ Timely Access to Care Act.