The American Hospital Association and American Medical Association are among the groups applauding Medicare Advantage prior authorization reforms included in a final rule issued by CMS April 5.
Here are four reactions to the prior authorization changes:
Editor's note: Responses have been lightly edited for clarity and length.
Anders Gilberg, Senior Vice President of Government Affairs, Medical Group Management Association: MGMA supports today’s action by CMS to finalize its proposals to reign in detrimental prior authorization practices, thereby strengthening the Medicare Advantage program. We are thankful that the agency heeded our call to finalize the continuity of care provision, limiting dangerous disruptions and delays to necessary patient care. By finalizing its proposal to require MA plans to form utilization management committees, CMS will provide greater consistency across MA and traditional Medicare's coverage decisions and guidelines. This rule is a step in the right direction to adequately address prior authorization reform.
Geraldine Jacobson, MD, Board of Directors Chair, American Society for Radiation Oncology: ASTRO applauds this final rule from CMS, which is a major step in reforming the broken, burdensome prior authorization system. Changes that increase transparency, reduce care disruptions and improve coverage criteria guidelines used by Medicare Advantage plans will bring much-needed relief to physicians and our patients with cancer. We appreciate that CMS addressed an array of concerns raised by ASTRO, the radiation oncology community and physicians nationwide.
The delays and interference associated with prior authorization are unnecessarily burdensome for radiation oncologists, who face the most significant prior authorization hurdles of any medical specialty. Based on ASTRO research, 90 percent of radiation oncology practices report that prior authorization delayed their patients’ access to life-saving cancer treatments, and a majority say the average delay lasts a week or longer.
Jack Resneck Jr., MD, President, American Medical Association: As the American Medical Association continues to analyze the details of a new final rule that revises Medicare Advantage and the Medicare prescription drug benefit, an initial read suggests that the Centers for Medicare & Medicaid Services has taken important steps toward right-sizing the prior authorization process imposed by Medicare Advantage plans on medical services and procedures. The AMA applauds CMS Administrator Chiquita Brooks-LaSure for leading the effort to include provisions in this final rule that will ensure greater continuity of care, improve the clinical validity of coverage criteria, increase transparency of health plans’ prior authorization processes, and reduce care disruptions due to prior authorization requirements. The AMA has long advocated for such meaningful prior authorization reforms and Medicare Advantage enrollees will benefit from the important new protections.
Ashley Thompson, Senior Vice President of Public Policy Analysis and Development, American Hospital Association: The AHA commends CMS for finalizing critical policies that will help ensure beneficiaries enrolled in Medicare Advantage have access to the medically necessary health care services to which they are entitled. In addition, we appreciate the agency’s increased attention to oversight of Medicare Advantage plans. Hospitals and health systems have raised the alarm that beneficiaries enrolled in some Medicare Advantage plans are routinely experiencing inappropriate delays and denials for coverage of medically necessary care. This rule will go a long way in protecting patients and ensuring timely access to care, as well as reducing inappropriate administrative burden on an already strained health care workforce.