Statement on CMS Proposed Rule Requiring Electronic Prior Authorization

By Soumi Saha, Senior Vice President, Government Affairs

The Centers for Medicare & Medicaid Services (CMS) proposed rule will help reduce the inexcusable inefficiencies and burdens that the highly manual and time-consuming prior authorization process places on patients and providers. Requiring expedited decisions by payers and the use of open FHIR-based application programming interfaces (APIs) and other interoperability standards, as well as increased data sharing between payors and providers, will streamline the current error-riddled, burdensome and costly process that leads to delayed care and patient harm. With record labor shortages, inflation and other demands in the healthcare sector, it is more critical than ever that providers are able to leverage technology to create efficiencies.

Premier is pleased that CMS proposes transparency requirements that will increase plan accountability for rampant prior authorization delays and denials. Premier will be evaluating the proposed new interoperability measures imposed on providers with an eye to ensuring that they are not creating new burden while attempting to alleviate the existing burden. Premier is also disappointed that the proposed rule lacks a recognition that innovative technology already exists to allow for real-time decisions from payers - CMS must be bolder in incentivizing payers to move to real-time responses.

Premier looks forward to providing input to CMS to help shape the final rule. In addition, Premier will continue to work with Congress to advance provisions in the bipartisan Improving Seniors' Timely Access to Care Act (H.R. 3173 / S. 3018) to close key gaps that exist in the proposed rule around payer transparency of prior authorization denials and approvals through the use of advanced technologies.