Healthcare providers welcome new federal regulations to simplify the cumbersome prior authorization process, which has long been criticized for administrative challenges. The Centers for Medicare & Medicaid Services (CMS) introduced a final rule to expedite authorizations through electronic means, with a deadline of 2026 for payers to respond within 72 hours for urgent requests and seven days for standard services. Denials must now include specific reasons.
The Centers for Medicare & Medicaid Services (CMS) maintains that the newly introduced policy will significantly improve the prior authorization process. This enhancement is projected to yield approximately $15 billion in savings over the next ten years, benefiting patients, healthcare providers, and payers alike. While the initiative has been met with general approval, specific healthcare organizations have raised issues regarding aspects they believe the regulations have overlooked. Notably, Premier, Inc., an alliance encompassing hospitals and healthcare providers, expressed concern that the regulation falls short of providing timely patient care.
The American Academy of Family Physicians sees the rule as progress but calls for further reforms to reduce the number of authorizations doctors encounter. Electronic prior authorization is considered beneficial, but policymakers are urged to address the overwhelming volume of these requests. The AAFP advocates explicitly for legislative approval to reduce authorization delays in Medicare Advantage programs.
The American Hospital Association expresses enthusiastic support for the new rule, emphasizing the frequent delays and burnout caused by the prior authorization process. The organization appreciates the plan to extend the rule to Medicare Advantage plans and create interoperable standards for transparency.
The American Medical Association, critical of the prior authorization process, applauds the move to electronic authorization in health records for increased automation and efficiency. The AMA also values the rule's transparency enhancements, including specific denial reasons and public reporting of program metrics. Collaboration with CMS is planned to extend improvements to drug prior authorization.
The Medical Group Management Association praises the regulations, stating that prior authorization demands have been a significant regulatory burden for medical groups. The rule is expected to standardize the process, with increased transparency provisions shedding light on payer practices under the guise of patient interests. Medical groups emphasize the need for an overall reduction in prior authorization requests.
