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OSMA Joins National Effort to Reform Prior Authorization in Medicare Advantage Plans


OSMA joined with 118 other state and national physician organizations urging CMS to finalize its efforts to reform prior authorization rules related to Medicare Advantage plan.


While we focus on prior authorization reform in Ohio that will impact commercial and Medicaid plans, Medicare Advantage plans are regulated federally and therefore reforms must occur through congressional legislative action or rulemaking by CMS. In the letter, we urged CMS to make sure the reforms focus on:


  • Strict timelines so prior authorization isn’t used as a tool to delay or discourage care.

  • Protecting patients from care interruptions, treatment delays, and unanticipated medical costs.

  • Creating alternatives and exemptions for providers to reduce administrative burdens like gold-carding programs.

  • Requiring automation and efficiency in systems administered by the health plans.


 Read the Full Letter >


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