Providers request more time to review prior authorization rule changes

The Medicaid and CHIP Payment and Access Commission, known as MACPAC, sent a letter to CMS Administrator Seema Verma saying healthcare providers need more time to review the agency's proposed rule to simplify prior authorizations.

On Dec. 10, CMS issued a proposed rule to streamline prior authorizations and create a better exchange of healthcare data between payers, providers and patients. Under the proposed rule, payers in Medicaid, Children's Health Insurance Program and Qualified Health Plan would build application programming interfaces to ease data exchange and prior authorizations.

In its Jan. 4 letter, MACPAC said the period CMS allotted for public comment on the proposed rule is too short. The period spans 17 days, three of which were federal holidays, which the commission wrote "is insufficient given the complexity of the proposed rule and the new requirements it will impose on states and health plans."

The commission also expressed concern about the proposed rule's exemption of Medicare Advantage plans from the new requirements, writing that "creating additional misalignments" between the two programs would complicate care integration. The American Hospital Association also criticized this, writing it was "deeply disappointed" CMS did not include Medicare Advantage plans in a Dec. 11 statement.


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