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Neurosurgery Lauds Proposed Rule to Streamline Prior Authorization

The Regulatory Relief Coalition (RRC), of which the AANS and the CNS are leaders, issued a press release lauding the Centers for Medicare & Medicaid Services (CMS) for its recently released proposed rule. The proposal — which applies to Medicare Advantage, Medicaid managed care, Children’s Health Insurance Program and federal Marketplace qualified health plans — closely aligns with the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018),legislation that unanimously passed the House by voice vote on Sept. 14, 2022. In the release, John K. Ratliff, MD, FAANS, former chair of the AANS/CNS Washington Committee, stated:

“Patients and physicians are thrilled that the proposed rule paves the way for commonsense, necessary, and appropriate changes to prior authorization in Medicare Advantage and other government health programs. Congress should take action before the end of this year and codify these vital principles by passing the Improving Seniors’ Timely Access to Care Act.”

CMS published a second proposal to address additional issues related to prior authorization in the Medicare Advantage program. Taken together, the proposed rules:

  • Aim to advance interoperability and improve prior authorization processes by requiring health plans to adopt electronic prior authorization;
  • Require plans to make prior authorization decisions within 72 hours for urgent requests and seven calendar days for others;
  • Ensure that prior authorization approvals remain valid for a patient’s entire course of treatment;
  • Mandate that Medicare Advantage plans follow traditional Medicare’s national and local coverage policies and stipulate that coverage determinations must be reviewed by professionals with relevant experience;
  • Support efforts, such as gold carding, 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.

Subsequently, on behalf of the Alliance of Specialty Medicine, Katie O. Orrico, Esq., AANS/CNS senior vice president for health policy and advocacy, attended a stakeholder roundtable convened by the Department of Health and Human Services and CMS. The roundtable was organized by CMS Administrator Chiquita Brooks LaSure, U.S. Surgeon General Vivek H. Murthy, MD, and other senior CMS officials, allowing participants to share their experiences with prior authorization. Also attending on behalf of the American Hospital Association was neurosurgeon James B. Chadduck, MD, FAANS.

Click here to read the Alliance’s press release about the roundtable.