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Lawmakers Release “Dear Colleague” Letter to CMS Regarding Prior Authorization

On Aug. 9, Reps. Phil Roe, MD, (R-Tenn.) and Ami Bera, MD, (D-Calif.) released a “Dear Colleague” letter, urging their congressional colleagues to join them in sending a letter to Centers for Medicare & Medicaid Services (CMS) Administrator, Seema Verma, MPH, asking CMS to provide guidance to Medicare Advantage (MA) plans regarding the use of prior authorization. The use of prior authorization by health plans has gotten out of control, and the AANS/CNS Washington Committee has identified this as a priority topic. Finding a solution is complicated, however, since individual states regulate most health plans. While the federal government has limited power to address prior authorization abuses in these plans, it does have the power to regulate MA plans. Since most health plans participate in MA, efforts by Medicare to control these plans may have a spillover effect in the state-regulated plan practices.