U.S. insurance providers committed to streamlining the prior authorization process in a roundtable with federal agencies, CMS said

WASHINGTON—Top United States health insurance providers pledged to streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace and commercial plans covering nearly eight out of 10 Americans, Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz announced on Monday, June 23. 

Katie Smith Sloan, president and CEO of the nonprofit provider association, released a statement in response to the Centers for Medicare & Medicare Services contract year 2026 Medicare Advantage & Part D proposed rule

WASHINGTON—LeadingAge, an association of nonprofit providers of aging services, released a statement from its president and CEO, Katie Smith Sloan, regarding on the recently released Centers for Medicare and Medicaid Services (CMS) contract year (CY) 2026 Medicare Advantage (MA) and Part D proposed rule. The full statement by Sloan is detailed below. 

Newly embedded prior authorizations in the Parachute platform reduce costs & streamlines administration for health plans, DME/HME providers & clinicians

NEW YORK—Parachute Health, the platform empowering simple durable medical equipment (DME) and home medical equipment (HME) ordering, announced the launch of its groundbreaking collaboration with two of the largest health care companies to revolutionize DME e-prescribing and now prior authorization while reducing costs for health plans, DME providers and clinicians.

Change will speed discharges & eliminate 14,000+ authorizations from the health care system

BOSTON—Blue Cross Blue Shield of Massachusetts ("Blue Cross") announced that it will remove prior authorization requirements for homecare services for commercial members beginning Jan. 1, 2024. This means hospitalized members will not be required to get advance approval before being discharged to continue treatment at home.

Homecare services include:


BELLEVUE, Washington (December 6, 2022)—Edifecs, Inc., a global health information technology solutions company and Empowered-Home, today announced a partnership to provide automated prior authorization to medical associations, Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), medical groups, and home health care agencies.

MESA, Ariz. (August 29, 2022)—In hiring Steve Gottfried to lead business development efforts, Myndshft, a fully automated end-to-end prior authorization platform, reaffirms its core mission of relieving health care providers, partners and payers from the complex, time-consuming administrative processes that undermine patient care. 

WASHINGTON, D.C. (January 15, 2021)—The Centers for Medicare & Medicaid Services (CMS) has finalized a signature accomplishment of the new Office of Burden Reduction & Health Informatics (OBRHI). This final rule builds on the efforts to drive interoperability, empower patients, and reduce costs and burden in the health care market by promoting secure electronic access to health data in new and innovative ways.


WASHINGTON, D.C. (May 31, 2019)—The Centers for Medicare & Medicaid Services (CMS) will be hosting two Special Open Door Forums (ODF) on June 4 and June 12, 2019.

Prior Authorization

On June 4, CMS will host an ODF from 2:00 pm to 3:30 pm EDT on the implementation of prior authorization (PA) for pressure reducing support surfaces. This ODF is a follow-up from an announcement published in the Federal Register on April 22.


(June 27, 2018)—The Integrated Care Resource Center (ICRC) recently released a briefing titled “Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the Fee-for-Service System.” As the title states, the brief explores the approaches of Connecticut, California and Illinois in ensuring dual-eligible beneficiaries receive the medical equipment they need.

Background

Recent report recommends extending and renewing current programs.

By Kristin Easterling

(May 24, 2018)—Recently, the Government Accountability Office (GAO) conducted a study on Medicare prior authorization requirements. The requirements began in seven states for certain power mobility devices such as power wheelchairs in 2012. The categories later expanded to include DME, home health and others.

—Via AAHomecare—WASHINGTON, D.C. (August 16, 2017)—Last year, CMS finalized the rule to move forward with expanding the prior authorization (PA) program. Although the program has great support from the industry, AAHomecare expressed concern with the lack of physician involvement in the correspondence of the PA decision. Unlike the PMD Demonstration, under the PA expansion, DME MACs cannot automatically communicate with referring physicians on the PA decision.