Prior Authorization
黑料正能量 Association (AHA) resources on health care insurance prior authorization, the impact of insurers' delays and rejections on patients, and the cost of these delays to hospitals and health systems.
The Centers for Medicare & Medicaid Services tonight released a proposed rule that would require Medicare Advantage, Medicaid and federally-facilitated Marketplace health plans to streamline processes related to prior authorization.
The AHA commends CMS for taking important steps to remove inappropriate barriers to patient care by streamlining the prior authorization process for some health insurance plans. Hospitals and health systems especially appreciate that CMS included Medicare Advantage plans in these requirements, as鈥
The AHA appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services鈥 (CMS) 鈥淢ake Your Voice Heard鈥 Request for Information (RFI) on promoting equity and efficiency in CMS programs. As requested in the RFI, we submitted our key recommendations using CMS鈥檚 electronic鈥
Certain commercial health insurer policies and administrative practices delay patient care, overburden clinicians and withhold critical payments from providers.
AHA today released the special edition podcast 鈥淗ow Prior Authorizations Can Harm Patient Care,鈥 addressing how some health plan prior authorization policies delay or deter necessary patient care, potentially putting patients鈥 lives at risk.
In medical care, prior authorization was originally intended to ensure patients received appropriate care that was in line with tested methodologies. Today, 鈥減rior authorization鈥 has become a dreaded term鈥ften signaling delayed care and undue financial burdens posed to patients and care providers鈥
AHA comments in response to the Centers for Medicare & Medicaid Services鈥 Request for Information regarding the Medicare Advantage program.
The cost of commercial insurance is increasing at an unsustainable rate 鈥 squeezing individuals and families, employers, and public programs. The average family insurance premium has increased 47% over the past 11 years 鈥 faster than general inflation and more than any other part of the health care鈥
In a letter to Representatives Richard Neal, and Kevin Brady, AHA voices support for the Improving Seniors鈥 Timely Access to Care Act of 2022 (H.R. 8487).
AHA expresses concerned about some MA plans鈥 inappropriate restrictions on beneficiary access to medically necessary care, including those highlighted in a recent report issued by the Department of Health and Human Services鈥 Office of Inspector General (HHS-OIG),