Sample Letter on Prior Authorizations - Please personalize for your use
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.