Proponents of prior authorization reform are optimistic about the slew of proposed rules that the administration says would reduce provider burden and lower workforce burnout, but now advocates are focused on next steps as the Congressional Budget Office reassesses the cost of a bill that would streamline the prior authorization process and transition it to an electronic system.
CMS issued three rules in the final months of 2022 aimed at revamping the prior authorization process. If finalized, the rules would increase transparency about the approvals and denials process, shorten the permissible waiting period for approvals, make the rationale behind denials available to patients and providers, and transition the system to an electronic prior authorization process. Now, CMS is unpacking elements of the proposed rules stakeholders feel are important ahead of the deadlines for comment submissions. An expert told Inside Health Policy the administration and advocates discussed in a stakeholder-only call on Tuesday (Jan. 17) how the proposed rules would impact provider burnout, transparency and patient awareness of the approvals process.
The expert told Inside Health Policy some stakeholders are encouraging CMS to beef up some of the components of the proposed rules, including tightening timelines for urgent and non-urgent prior authorizations and improving peer-to-peer approvals conversations to align specialists seeking a prior authorization with a peer from their specialty.
Meanwhile, a bill meant to transition prior authorizations to an electronic system accrued huge bipartisan support in both the House and Senate last year, but ultimately fell short. The Congressional Budget Office slapped a $16 billion price tag on the legislation shortly after it passed the House, and lawmakers’ year-end deal came together before CBO had time to rescore the bill -- though lobbyists said rescoring it while factoring CMS' proposed rules into the cost could lower the cost by half.
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