• Letter or Testimony
  • January 6, 2021

CHA comments on proposed rule to streamline prior authorizations through electronic data exchange

We submitted comments to CMS on a proposed rule to require Medicaid, CHIP and Exchange plans to include information about a patient’s pending and active prior authorization decisions in the application programming interfaces (APIs or “apps”) that they are required to develop under the final Interoperability and Patient Access final rule. The rule also requires payers to shorten their prior authorization review and approval deadlines and publicly report data on their decisions. 

Our high-level comments note general support for the rule’s electronic information exchange requirements for payers to patients, payers to providers, and payers to payer with recommendations to ensure confidentiality for adolescent patients and children in volatile family situations. They also express support for the standardization of electronic prior authorization processes and shortened timelines across plans, but urge further shortening of those timelines beyond what is proposed. We also highlight aspects of the proposed rule’s prior authorization processing and transparency that we believe can be further improved to support the care of pediatric patients. 

We also joined with other provider and payer organizations in a letter to CMS requesting an extension in the proposed rule’s 25-day comment period.