The ACC, in coordination with numerous leading national medical societies, has asked the Centers for Medicare and Medicaid Services (CMS) to encourage Medicare Advantage (MA) plans to waive prior authorization requirements for the duration of the national COVID-19 emergency.

Recently, CMS announced that MA plans would be granted flexibility to waive prior authorization requirements during the crisis. However, given the scope and severity of the current public health crisis and its impact of clinical practice, more direction from CMS is required to encourage MA plans to fully utilize this flexibility.

As result of the CMS guidance to limit adult elective surgery and procedures last month, only unavoidable surgeries and vital medical procedures are being prioritized for immediate care. Removing any barriers to this timely care frees up much needed hospital and physician practice resources which are operating on significantly reduced staff.

Current prior authorization rules make it increasingly difficult for practices to devote physician, nursing and administrative staff to the task of seeking approvals for urgently needed services.

Prior authorization reform has long been an ACC Advocacy priority. While even more important now, ensuring patient access to appropriate cardiovascular care and minimizing unnecessary hurdles is key to optimizing patient care and outcomes no matter the circumstance.

Members can report data from pre-authorization requestors on disputed requests and denials to determine trends of inappropriate prior authorization decisions and help inform ACC Advocacy efforts using the College's Prior Authorization Reporting Tool (PARTool) here.

Clinical Topics: COVID-19 Hub

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Medicaid, COVID-19, Coronavirus, Severe Acute Respiratory Syndrome

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