The ACC submitted comments to the Centers for Medicare and Medicaid Services (CMS) on March 13 regarding its proposed rule aimed at improving interoperability and prior authorizations in Medicare Advantage and other programs through the adoption of e-prior authorization programs.

The proposed rule intends to standardize e-prior authorization processes for certain payers including Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children’s Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-facilitated Exchanges (FFEs). It builds on proposals in the Interoperability and Information Blocking Final Rules developed as part of the 21st Century Cures Act and closely follows provisions in the Improving Seniors’ Timely Access to Care Act, a priority bill for the ACC Advocacy team that if enacted would minimize administrative burden by streamlining the process for Medicare Advantage patients while increasing transparency.

The ACC had previously submitted comments on a similar proposed rule. However, this update formally withdraws and replaces that 2020 rule and includes proposals for the development of Fast Healthcare Interoperability Resources (FHIR)-based patient access, provider access, and payer-to-payer data exchange application programming interfaces (APIs). It is important to note this proposed rule expands on the 2020 rule and includes Medicare Advantage, but does not include prescription drug and/or covered outpatient drug information.

Access ACC’s comment letter here.

Keywords: ACC Advocacy, United States, Medicaid, Medicare Part C, Prior Authorization, Centers for Medicare and Medicaid Services, U.S., Prescription Drugs, Children's Health Insurance Program, Outpatients, Insurance, Health, Health Services Accessibility

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