Prior Authorization Rule Withdrawn?

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The Biden administration appears to have withdrawn a final rule aimed at streamlining prior authorization. The rule had required payers with plans in Medicaid, the Children’s Health Insurance Program and those operating on the federal exchanges to use standardized application programming interfaces to give providers and patients electronic access to prior authorization data, including pending decisions. It also required payers to issue faster decisions on prior authorization requests.

Withdrawn Rule

According to reports, press releases supporting the rule no longer appear on the CMS website and the rule also does not appear on the Federal Register. However, CMS did not say why the rule appeared to have been withdrawn. As reported in Fierce Healthcare, an agency spokesperson said: “This matter is currently under CMS review and we look forward to sharing additional information about this program soon”. However, the article notes the rule could still possibly survive, as regulations affected by a White House call to freeze last minute Trump-era regulations can be approved by an agency or department head.

It was noted in other publications that AHIP had strenuously opposed this rule, quoting their CEO when the final rule was announced,

“Today’s final rule from CMS is largely a series of empty promises. This shabbily and hastily constructed rule puts a plane in the air before the wings are bolted on by requiring health insurance providers to build these technologies with incomplete and untested instruction manuals,” AHIP’s CEO Matt Eyles said.

“Miraculously, the Administration was able to provide the ‘reviews’ and ‘responses’ in less than nine business days despite over 250 stakeholders filing thousands of pages of public comments. This was wholly inadequate to allow stakeholders to conduct appropriate analyses and was clearly not consistent with the thoughtful notice-and-comment approach to developing policies that is customarily afforded a rule estimated to cost nearly $3 billion to implement,” Eyles continued.

When the rule was released, it was strongly backed by CMS leadership. “Thanks to this rule, millions of patients will no longer have to wrangle with prior providers or locate ancient fax machines to take possession of their own data,” CMS Administrator Seema Verma said in a statement. “Many providers, too, will be freed from the burden of piecing together patients’ health histories based on incomplete, half-forgotten snippets of information supplied by the patients themselves, as well as the most onerous elements of prior authorization. This change will reverberate around the healthcare system for years and decades to come.”

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