American College of Rheumatology: Proposed Rule Will Bring Great Transparency to Medicare Advantage Prior Authorization Decisions

Calls on Congress to prioritize prior authorization reform bill in year-end package

WASHINGTON, DC – The American College of Rheumatology (ACR) today said the Centers for Medicare and Medicaid Services’ (CMS) Advancing Interoperability and Improving Prior Authorization Proposed Rule will bring greater transparency, reduce administrative burden, and make turnaround on prior authorization more predictable for certain payers, including Medicare Advantage payers.

The ACR said that while it continues to review the proposed rule’s technical components, it appreciates CMS recognizing the burden patients and providers endure due to prior authorizations and appreciates the agency’s policy proposals to mitigate roadblocks to patient access to care.

Urging Congress to swiftly include prior authorization reform in the year-end legislative package, the ACR says the proposed rule expands on the House-passed Improving Seniors Timely Access to Care legislation and demonstrates that the cost to payers to implement the rule would be negligible.

Additionally, with the proposed rule’s language, the ACR anticipates the Congressional Budget Office to significantly decrease the cost of the bill. The ACR calls on Congress, with this new information, to act quickly and include the prior authorization fix in the upcoming omnibus legislation.

“Patients and physicians are fed up with the delays, denials and run-around related to overly complicated prior authorization procedures,” said Douglas White, MD, PhD, President of the ACR. “CMS’ rule to bring transparency and reduce administrative burden is a good first step, but still more can and should be done to increase timely access to therapy. That’s why the ACR continues to urge Congress to codify the Improving Seniors' Timely Access to Care Act in the year-end legislative package.”

If finalized, the rule will be implemented in January 2026.

Media Contact
Amanda Head
ahead@rheumatology.org
404-679-5330

###

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.