Washington E-Newsletter

Congress Urges CMS to Finalize Prior Authorization Rules

Nearly 300 bipartisan members of Congress signed letters urging the Centers for Medicare & Medicaid Services (CMS) to finalize proposed regulations to increase transparency, streamline and standardize prior authorization (PA) in the Medicare Advantage (MA) program. Sixty-one senators and 233 members of the House of Representatives signed the letters to U.S. Department of Health and Human Services Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.

The letters also urged the agency to align the final rules with the Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173) by:

  • Establishing a mechanism for real-time PA decisions for routinely approved services;
  • Requiring MA plans to respond to PA requests for urgently needed care within 24 hours; and
  • Requiring MA plans to report detailed transparency metrics related to delays, denials and appeals.

The AANS and the CNS issued a press statement joining Congress in calling on CMS to swiftly finalize these PA reforms. In the press release, Russell R. Lonser, MD, FAANS, chair of the AANS/CNS Washington Committee, stated:

Our message to policymakers is simple: our patients cannot afford to wait or jump through unnecessary hoops to get care for painful, debilitating and life-threatening neurologic conditions. When finalized, these rules would remove barriers to patients’ timely access to care and allow physicians to spend more time treating patients and less time on paperwork.

Dr. Lonser was also featured in a Regulatory Relief Coalition press release, stating, “Congress has seen the harm that MA overreach has on seniors and the physicians who care for them. Millions of Medicare Advantage patients are frustrated by delays and denials of care. Our patients are demanding action from policymakers, and it’s clear that our patients are being heard.”