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Hospitals, Physicians, Health Insurance Providers Urge CMS Not to Implement Costly, Conflicting Prior Authorization Standards

Press Release

woman going into a MRI machine

Published Jul 27, 2023 • by AHIP

Washington, D.C. – July 27, 2023 – In a remarkable demonstration of unity, AHIP, the American Medical Association (AMA), the American Hospital Association (AHA), and the Blue Cross Blue Shield Association (BCBSA) came together to urge the Centers for Medicare & Medicaid Services (CMS) to reconsider prior authorization standards the agency has proposed.

The leading health care associations agree: The inclusion of prior authorization standards in the Administrative Simplification proposed rule would conflict with the standards proposed in the Interoperability and Prior Authorization rule, which would “set the stage for multiple [prior authorization] electronic standards and workflows and create the very same costly burdens that administrative simplification seeks to alleviate.”

Moving forward with 2 sets of standards would run counter to the goals of administrative simplification, cause confusion, slow implementation, and unnecessarily increase costs, the letter said. For these reasons, the organizations strongly advise against adoption of prior authorization standards within the Administrative Simplification final rule.

Click here for more information on AHIP’s positions on prior authorization.

About AHIP

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.