AAHKS Comments on Prior Authorization Proposed Rule

This week, AAHKS sent comments to CMS regarding its proposed rule on Advancing Interoperability and Improving Prior Authorization Processes. Our comments include supporting CMS’ proposals to improve the prior authorization process through requiring payers to adopt a Prior Authorization Requirements, Documentation, and Decision (PARDD) Application Programming Interface (API) to streamline and reduce critical burdens associated with the current prior authorization framework and require payers to include certain information with prior auth denials as a first step to ensure payers’ clinical criteria relies on peer-reviewed, evidence-based guidelines reviewed by qualified experts. In addition, the letter supports establishment of specific prior auth timeframes to reduce the unpredictable and lengthy amount of time AAHKS members and their patients often wait to receive payer decisions, a proposal to require payers to publicly report prior auth metrics and utilization of gold-carding programs for providers. Our comments also encourage CMS to ensure the agency takes patient and provider impacts into account when considering imposing any future provider-side changes to advance interoperability. Read our letter for more information.