Improving Prior Authorization

On March 13, 2023, IPSIS submitted comments in response to the Centers for Medicare and Medicaid Services (CMS) Advancing Interoperability and Improving Prior Authorization Process Proposed Rule.

The letter voices appreciation and acknowledges CMS’s recognition of the challenges associated with prior authorization (PA) programs. SIS recommends that CMS:

• reduce the time period for expedited (24-hours) and standard (48-hours) PA requests
  
• establish clear and enforceable guidelines that hold payers accountable for timely processing of PA requests
• require impacted payers to honor PA approvals from the previous payer for at least 90 days

The proposed rule extends to Medicare Advantage in addition to Medicaid and federally-facilitated Marketplace health plans, promoting alignment of PA requests across coverage types. If finalized, the proposed provisions would go into effect January 1, 2026. Click here 🔒 to read IPSIS’ members-only preliminary analysis.

You can also help sustain this vital advocacy with your donations. The International Pain and Spine Intervention Society (IPSIS) is a tax-exempt organization under US section 501(c)(3) of the Internal Revenue Code. As such, contributions are deductible to the extent allowed by law.