OSMA Comments on Federal Prior Authorization Rules
Prior Authorization reform is OSMA’s top advocacy issue in 2023 and 2024. In addition to advocating for major legislative reforms at the state level that will impact commercial and Medicaid plans, we have also been involved in initiatives at the federal level that will impact Medicare advantage plans.
The Centers for Medicare and Medicaid Services (CMS) is currently considering two different rule reforms that address many of the issues physicians have with prior authorization. Last month, OSMA joined the AMA and other state medical associations in commenting on one set of rules and last week we submitting comments to CMS on another package of rules.
CMS also recently solicited comments on the proposed rules to improve the prior authorization (PA) process. The rules addressed various process and administrative issues with PA, including requiring: additional publicly available data on PA from plans (percent of approval/denials, types of services and items requiring PA, etc.), reasons for specific denials to patients and providers, and specific time frames for PA request decisions from plans.
OSMA, encouraged by the proposed changes, commented generally in support—but also recommended more improvements.
Further information on the rules can be found here: