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AAHomecare Calls for Transparency, Consistency and Timeliness in Prior Auth Process for Medicare Advantage Plans

Source: American Association for Homecare Insider 3/22/2023


On March 10, AAHomecare submitted comments to CMS’ proposed rule on advancing interoperability and improving Prior Authorization processes (CMS-0057-P).  In the rule, CMS proposes to standardize the Prior Authorization (PA) process for Medicare Advantage (MA) programs. CMS’ proposal includes to require payers to implement and maintain an Application Programming Interface (API) to support and streamline the PA process; respond to PA requests within certain timeframes; provide a clear reason for PA denials; and publicly report on PA approvals, denials and appeals. CMS states that while this proposed rule does not directly affect Medicare FFS, if these rules are finalized, the Medicare FFS program would modify its PA programs to align with these rules.

AAH supports the CMS’ policy objective of PA requirements and CMS’ design to improve the PA process for payers, providers, and patients. Transparency, consistency and timeliness in the PA system are paramount to ensure patients maintain access to appropriate care. One component of the PA process that is critical, but is not expressly addressed in the proposals is the need for an impartial and expeditious appeal process for PA requests that are denied. AAHomecare would support the modifications made in the proposed rule to the Medicare FFS PA process for DME items if CMS adopts the additional improvements recommended in the letter.
You can find AAHomecare’s full comments here.

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