Comment Letter

House Letter Urging CMS to Finalize Prior Auth Rules

  • Reimbursement and Practice Management
  • The Honorable Xavier Becerra
    U.S. Department of Health and Human Services
    200 Independence Avenue, S.W.
    Washington, D.C. 20201
  • The Honorable Chiquita Brooks-LaSure
    U.S. Centers for Medicare & Medicaid Services
    7500 Security Boulevard
    Baltimore, M.D. 21244

Dear Secretary Becerra and Administrator Brooks-LaSure:

We write to thank the U.S. Centers for Medicare & Medicaid Services (CMS) for taking action toward ensuring timely access to health care by proposing rules to streamline prior authorization (PA) protocols for individuals enrolled in federally-sponsored health insurance programs, including Medicare Advantage (MA) plans.1, 2, 3 We urge CMS to promptly finalize and implement these changes to increase transparency and improve the prior authorization process for patients, providers, and health plans. We also urge CMS to expand on these proposed rules by: (1) establishing a mechanism for real-time electronic prior authorization (e-PA) decisions for routinely approved items and services; (2) requiring that plans respond to PA requests within 24 hours for urgently needed care; and (3) requiring detailed transparency metrics.

Click here to read the full House Letter Urging CMS to Finalize Prior Auth Rules.