ASNC Supports CMS Proposal to Streamline Prior Authorization

In these comments to the Centers for Medicare & Medicaid Services (CMS), ASNC communicated support for proposed policy changes intended to streamline and improve transparency of prior authorization (PA) processes across health plans, including by requiring support of electronic PA via a standards-based application programming interface. The proposed policies would apply to Medicare Advantage, Medicaid, CHIP and Qualified Health Plans on the Federally Facilitated Exchanges.

ASNC also noted support for CMS’s proposal to shorten the timeline for PA decisions while requesting the agency should finalize a timeline of 48 hours for standard requests and 24 hours for urgent requests, rather than the agency’s proposed one week for standard requests and 72 hours for urgent requests.

In addition, ASNC asked CMS to finalize rules for transparency that would require reporting of more granular information about plan approvals and denials based on specialty or service rather than just in aggregate. ASNC also gave support to a proposed requirement for health plans to provide a specific reason for a PA denial.

Read Comments Letter