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The AHA today praised a Centers for Medicare & Medicaid Services’ proposed rule that would remove inappropriate barriers to patient care by streamlining the prior authorization processes for the impacted health plans; however the association said it was deeply disappointed that CMS chose not to include Medicare Advantage plans, “many of which have implemented abusive prior authorization processes that act as a detriment to the provision of efficient and timely patient care,” in the rule.  

In addition, while hospitals and health systems appreciate CMS establishing timeframes for prior authorization decisions, AHA said the proposed timelines for urgent and non-urgent care are insufficient to protect patients and promote appropriate care.

“We urge CMS to reconsider the omission of MA plans and tighten the prior authorization decision timeframes in order to promote timely care and patient safety,” AHA said.

See the letter for AHA’s detailed comments on the proposed rule.