Statement on the Final Rule on Interoperability and Electronic Prior Authorization

By Soumi Saha, Senior Vice President, Government Affairs

The Centers for Medicare & Medicaid Services (CMS) final rule takes important steps to help reduce the inexcusable inefficiencies and burdens that the highly manual and time-consuming prior authorization process places on patients and providers. Requiring the use of open FHIR-based application programming interfaces (APIs) and other interoperability standards, as well as increased data sharing between payers and providers, will streamline the current error-riddled, burdensome and costly process that leads to delayed care and patient harm. Premier is also pleased that CMS finalized transparency requirements that will increase plan accountability for rampant prior authorization delays and denials.

While Premier appreciates CMS’ commitment to codifying required deadlines for prior authorization decisions by payers, postponing care for potentially up to seven days is still untenable when a patient’s health is on the line. Instead of making patients and providers play a dangerous waiting game, Premier maintains that CMS should require payers to deliver responses within 72 calendar hours for standard, non-urgent services and within 24 calendar hours for urgent services.

Premier is also disappointed by the final rule’s lack of acknowledgement that a pathway to real-time prior authorization exists. CMS missed a valuable opportunity to develop incentives to move payers and providers closer to real-time processes using innovative technologies. 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 will continue to push Congress to act on issues that CMS failed to address in the final rule.