Medicare Advantage prior authorization rule drops
Medicare Advantage plans and other government-funded insurers would have to overhaul the electronic process they use to approve medical services and prescriptions under a rule proposed by the Biden administration on Tuesday.
Why it matters: Prior authorization is a top concern of physicians, who say it imposes excessive administrative burdens and have pressed Congress to make changes in the lame-duck session. The rule could dramatically reduce the cost of a Medicare Advantage prior authorization fix.
- Prior authorization requirements were "very or extremely burdensome" for nearly 82% of respondents to a Medical Group Management Association survey conducted earlier this year.
- More than half of respondents to an American Medical Association survey said the requirements often or always lead to patient care delays.
Yes, but: Insurers say prior authorization is a necessary tool to control costs and make sure care is effective and efficient.
- AHIP, a major trade organization for health plans, supports electronic prior authorization as a way to improve the system.
Flashback: CMS initially proposed to improve electronic data exchange among health care payers, providers and patients in the final days of the Trump administration. But the original rule just applied to Medicaid, CHIP and Qualified Health Plans. CMS never finalized the policy.