FAH Hospital Policy Blog

Perspectives on health policy affecting America's hospitals and the patients we serve.

Medicare | Managed Care | FAH Policy Blog Team

FAH Urges CMS to Implement Prior Authorization Improvements

Today, FAH sent comments to CMS on its proposed rule on Advancing Interoperability and Improving Prior Authorization Processes.  FAH urges CMS to finalize patient protections in the rule, including shortening the health plan response times for prior authorization requests, requiring that plans give providers specific reasoning for denials, and establishing health plan reporting requirements of prior authorization metrics.  FAH also supported CMS proposals to require health plans to adopt and use a new data exchange platform for prior authorization processes using FHIR APIs for communications with patients, providers, and other plans.  However, FAH urged CMS to improve standards and test these new data exchange platforms to ensure successful implementation.

Additionally, FAH urged CMS to ensure any potential delays of the new electronic prior authorization platforms do not delay the needed prior authorization policy improvements.

A copy of the letter is available here.