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Congress Urges CMS to Take Action on Prior Authorization

Restricting abusive prior authorization tactics is a top issue for organized neurosurgery, as such the AANS and CNS are leading an advocacy effort to reduce the burdens of prior authorization practices for Medicare Advantage (MA) and other health plans. Due to neurosurgery’s advocacy, Reps. Phil Roe, MD, (R-Tenn.) and Ami Bera, MD, (D-Calif.) spearheaded a letter among their colleagues in the U.S. House of Representatives urging the Centers for Medicare & Medicaid Services (CMS) to improve how prior authorization works under MA. Signed by 103 bipartisan House members, the letter to CMS Administrator Seema Verma notes, “patients may be encountering barriers to timely access to care that are caused by onerous and often unnecessary prior authorization requirements.” It goes on to urge CMS do the following:

  • Issue guidance to MA plans to dissuade the widespread use of prior authorization and to provide direction to the health plans to increase transparency, streamline prior authorization and minimize the impact on patients;
  • Ensure that these requirements do not create inappropriate barriers to care for Medicare patients; and
  • Collect data on the scope of prior authorization practices — including denial, delay and approval rates.

The AANS and CNS issued a press release thanking these lawmakers for asking CMS to take action on prior authorization. The statement was picked up by Inside Health Policy, which ran a story noting that the AANS and CNS were pleased with the letter because neurosurgeons often run into prior authorization hurdles before their patients can receive care. Quoting Ann R. Stroink, MD, FAANS, chair of the AANS/CNS Washington Committee, the piece stated, “Prior authorization — a tool insurance companies use to limit the medical services they cover — is a cumbersome process that we believe is being inappropriately used by Medicare Advantage plans.”

10-26 E-news-TOC