Statement attributable to:
Ryan D. Mire, MD, MACP
WASHINGTON December 7, 2022 – ACP commends the Centers for Medicare and Medicaid Services (CMS) for publishing a proposed rule that would require a number of categories of health insurers to implement specific processes intended to improve the electronic exchange of health care data and streamline processes related to prior authorization. Current approaches to prior authorization cause unnecessary delays in patient care and burdensome administrative roadblocks that prevent physicians from spending more time caring for their patients. Therefore, ACP is pleased that this proposed rule addresses these problems by requiring covered insurers to implement electronic prior authorization standards and better utilize and share patient data to streamline prior authorization processes. Additionally, the proposed rule requires covered payers to provide a specific reason when they deny a prior authorization request and requires prior authorization decisions to be sent within 72 hours for urgent requests and seven calendar days for nonurgent requests – while also seeking comments on a potentially shorter time frame. ACP also favors proposed payer rules that would enable/facilitate a longitudinal health record, if a patient opts in to sharing their data.
While ACP would like to see these prior authorization improvements implemented by all payer categories, insurer-types covered by this rule include Medicare Advantage (MA) organizations, state Medicaid and CHIP Fee-for-Service (FFS) programs, Medicaid managed care plans and Children’s Health Insurance Program (CHIP) managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs).
ACP has long advocated through our Patients before Paperwork effort for the reduction of administrative burdens that impede patient care. This rule is an important step forward in protecting patients from unnecessary delays in care and reducing administrative burdens on physicians. ACP calls on CMS to finalize this rule with the strongest possible policies for ensuring physicians’ ability to provide seamless evidence-based care for their patients without unnecessary administrative delays. It is also imperative that Congress complete its work on the Improving Seniors’ Timely Access to Care Act, which has already been passed by the House of Representatives and would codify necessary improvements to prior authorization processes for MA organizations.
About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 160,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.
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