Patient Advocacy – Call to Action

The Honorable Chiquita Brooks-LaSure Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244-1850

Submitted electronically to regulations.gov

Re: [CMS-0057-P] Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program

Dear Administrator Brooks-LaSure,

I encourage the Centers for Medicare and Medicaid Services (CMS) to adopt the proposed rule requiring  Medicare and Medicaid programs to improve and streamline the Medicare Advantage (MA) electronic prior authorization (e-PA) requirements.

As a physician I have seen first-hand how managed care denials of prior authorizations for vital, sight-saving care negatively impact a patient’s quality of life. Members of Congress highlighted how Medicare Advantage Plans’ use of prior authorizations creates barriers to patient care for their constituents. In the 117th Congress, a bipartisan coalition of over half the Senate, three quarters of the House, and over 500 organizations from across all sectors (patients, providers, pharmaceutical industry, medical technology groups, etc.) rallied around the Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173). Last fall, the House passed the legislation on a unanimous voice vote. Unfortunately, the original Congressional Budget Office scoring caused a delay in the bill’s passage through the Senate, leaving this issue still unaddressed.

Overuse/misuse of prior authorization creates considerable challenges for patients, providers, and payers, including detrimental delays in patient care. It can create additional work for both payer and providers. The additional administrative burden of the prior authorization process contributes significantly to provider burnout.

The e-Prior Authorization Proposed Rule and legislation would

•         Require MA plans to adopt e-PA;

•         Ensure timely response from MA plans to PA requests;

•         Require public reporting on the use of PA;

•         Support waiver or modification of PA requirements based on provider performance; and

•         Recognize that health plans’ proprietary interfaces and web portals through which providers submit their requests remain inefficient and burdensome.

I strongly support these proposed regulatory changes that mirror the legislation. I urge the agency to swiftly finalize these policies in 2023 to ensure that all Medicare beneficiaries have equal access to covered benefits.

Sincerely,