News and Publications

CMS Proposed Rule Aims to Bring Prior Authorization Relief

January 5, 2021

On December 10, the Center for Medicare and Medicaid Services (CMS) released the Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information CMS-9123-P proposed rule. Intended to streamline prior authorization processes and facilitate better electronic exchange of healthcare information, this rule would require Medicaid, Children’s Health Insurance Plans (CHIP), and Qualified Health Payers to utilize systems that streamline documentation requirements, and allow for electronic submission and approval of prior authorization requests.

The proposed rule addresses workflow issues that make the prior authorization process burdensome for providers, including requiring payers to report a prior authorization decision within a specific timeframe, the reduction or elimination of fax machine use, standardization of the documentation requirements for prior authorization submission, and more. ASTRO generally agrees with CMS’ proposals, but strongly encouraged CMS to apply prior authorization reforms to Medicare Advantage plans to more broadly alleviate undue hardship.

For more information, see ASTRO’s Summary and Comment Letter.