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AHIP Statement: Final Rule On Prior Authorization And Patient’s Electronic Access To Health Information Misses Mark In Improving Health Care

posted by AHIP

on January 15, 2021

Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP), issued this statement following the release by the Centers for Medicare & Medicaid Services (CMS) of the “Reducing Provider and Patient Burden by Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information” final rule.  Read the CMS press release.

Every day, our member organizations are working tirelessly to harness new technologies to share information with consumers and their providers in a secure fashion. Health insurance providers are innovating to streamline processes, improve the quality of care, reduce costs, and enhance the overall care experience.

Unfortunately, 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. And, despite rushing the rule, this Administration requires insurance providers to build expensive IT bridges to nowhere by failing to establish comparable requirements for providers or their IT vendors to use the technologies.

This Administration conducted the shortest rulemaking process on a major healthcare rule that anyone can remember. This unprecedented timeline afforded stakeholders only 14 business days to comment. 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.

Health insurance providers are committed to achieving a well-connected health care system that works better for patients, providers, and all stakeholders.  But this half-baked, midnight rule cannot be implemented as written, leaves patients’ sensitive data vulnerable to bad actors, and detracts from the critical work at hand defeating COVID-19.

Please click here to view CMS’s press release and here to view CMS’s fact sheet.


About AHIP

AHIP is the national association whose members provide coverage for health care and related services to hundreds of millions of Americans every day. Through these offerings, we improve and protect the health and financial security of consumers, families, businesses, communities and the nation. We are committed to market-based solutions and public-private partnerships that improve affordability, value, access, and well-being for consumers. Visit www.ahip.org for more information