U.S. Reps. Larry Bucshon (R-IN) and Mike Kelly (R-PA) joined a bipartisan, bicameral contingent of lawmakers in commending the Centers for Medicare & Medicaid Services (CMS), which on Jan. 17 finalized the CMS Interoperability and Prior Authorization Final Rule.
“Today’s action by CMS is a major win for seniors and their families,” the eight lawmakers said in a joint statement released on Wednesday. “These new regulations will make a big difference in helping seniors access the medical care they are entitled to without unnecessary delays and denials due to prior authorization.
“The regulations will also enable healthcare providers to focus on delivering better care rather than wasting hours on the phone with insurance companies,” they added.
Specifically, the rule sets requirements for Medicare Advantage organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, CHIP-managed care entities, and issuers of Qualified Health Plans offered on the federally facilitated exchanges to improve the electronic exchange of health information and prior authorization processes for medical items and services, according to CMS.
Among the lawmakers who joined Rep. Bucshon and Rep. Kelly in releasing the statement were U.S. Rep. Suzan DelBene (D-WA) and U.S. Sen. John Thune (R-SD).
“While these regulations could have gone further, they will help bring the antiquated prior authorization system into the 21st century with common-sense changes like a streamlined approval process and increased transparency,” the lawmakers said.
They also called on Congress to pass the bipartisan, bicameral Improving Seniors’ Timely Access to Care Act, which is part of the Health Care Price Transparency Act of 2023, H.R. 4822, a sweeping package of healthcare legislation.
Rep. Kelly and Rep. Bucshon led the Improving Seniors’ Timely Access to Care Act in the U.S. House of Representatives to modernize the prior authorization process in Medicare Advantage, which often still requires faxing documents to insurance companies.