WASHINGTON, D.C. – (January 17, 2024) – AHIP released this statement following the Centers for Medicare & Medicaid Services (CMS) publishing the Interoperability and Prior Authorization Final Rule.
“It's crucial that we all work towards ensuring patients have access to the information they need to make informed healthcare decisions. CMS took a step in the right direction by finalizing the Interoperability and Prior Authorization rule. Health insurers have been diligently working to build the infrastructure to expand data sharing with patients, providers, and other payers. With this rule CMS creates a roadmap for public and private payers in federal programs to work in tandem with providers to put this preparatory work into practice to improve patient access, outcomes, affordability, and experience.
“Electronic prior authorization is one such avenue that can help us maintain the necessary checks to ensure patients receive safe and evidence-based care while reducing decision times to get patients to care faster and administrative burdens on providers and plans. For patients and providers in the MA program, the new rules are on top of additional process and transparency improvements and other requirements that CMS has implemented for prior authorization.
“We appreciate CMS's announcement of enforcement discretion that will permit plans to use one standard, rather than mixing and matching, to reduce costs and speed implementation. However, we must remember that the CMS rule is only half the picture; the Office of the Coordinator for Health Information Technology (ONC) should swiftly require vendors to build electronic prior authorization capabilities into the electronic health record so that providers can do their part, or plans will build a bridge to nowhere.
“We cannot afford to delay any further when it comes to implementing electronic prior authorization capabilities. Let's work together to ensure that we can provide patients with the best possible healthcare experience while reducing administrative burdens on providers and plans.”
AHIP is the national association whose members provide health care coverage, services, and solutions to hundreds of millions of Americans every day. We are committed to market-based solutions and public-private partnerships that make health care better and coverage more affordable and accessible for everyone. Visit www.ahip.org to learn how working together, we are Guiding Greater Health.