American College of Rheumatology Applauds CMS Prior Authorization Rule

WASHINGTON, DC – The American College of Rheumatology (ACR) today submitted comments to the Centers for Medicare and Medicaid Services (CMS) administrator Chiquita Brooks-LaSure commending the agency for recognizing in its 2023 prior authorization proposed rule, the undue burden prior authorization policies have on healthcare providers, which too often result in care delays or denial for patients.

In its comment letter, the ACR noted “prior authorizations are supposed to ensure that the healthcare system is driven by evidence-based medicine to make sure proper treatment is administered without unnecessary costs. Sadly, prior authorizations have become a way to hinder, deter, or prevent the services and treatments that allow providers to treat their patients effectively.”

Specifically, in its comment letter to CMS, the ACR recommends:

• Expanding prior authorization guidance beyond medical services to include policies for all utilization management tools for services and therapeutics, including step-therapy policies.
• Shortening the decision timeline to 24 hours for urgent requests.
• Including therapeutics in prior authorization policies and issue additional sub-regulatory guidance on step-therapy policies that will not jeopardize patients' access to necessary treatments.
• Continuing the requirement already included in the proposed rule for payers to provide the reason for prior authorization denials.
• Excluding e-prior authorization measures for MIPS-eligible providers under the Performance Improvement (PI) category until Electronic Health Records (EHRs) can report this measure without additional burden to providers.

“Prior authorizations put an undue burden on providers seeking to do what is in the best interests of their patients,” said Douglas White, MD, PhD, President of the American College of Rheumatology. “The ACR appreciates the consideration that went into this comprehensive rule, and we look forward to working with CMS to implement policies related to improving the prior authorization process. We hope these policies will provide relief for providers while also ensuring patients receive the care they need.”

 

Media Contact
Monica McDonald
mmcdonald@rheumatology.org
404-365-2162

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About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 8,500 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.