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.
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.
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.
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:
WASHINGTON—On Monday, Nov. 6, the Biden-Harris Administration proposed steps to fix Medicare Advantage's (MA) use of prior authorization as well as curb predatory marketing within MA plans.
BIRMINGHAM, Alabama—Medicare Advantage plans denied two million prior authorization requests for health care services in whole or in part in 2021, or about 6% of the 35 million requests submitted on behalf of enrollees that year, a new analysis from the Kaiser Family Foundation found.
WASHINGTON (December 7, 2022)—The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that it says would improve interoperability and streamline processes related to prior authorization for medical items and services.
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. (November 23, 2021)—Bipartisan legislation introduced in the United States Senate would ease, standardize and speed the process of prior authorization in Medicare Advantage plans.
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.
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.
WASHINGTON, (April 18, 2019)—The Centers for Medicare & Medicaid Services (CMS) has selected 12 additional items of Durable Medical Equipment (DME) to be subject to required prior authorization (CMS 6080-N2).
(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
WASHINGTON, D.C. (June 4, 2018)—On Friday, June 1, 2018, CMS released CMS-6080-N, “Medicare Program; Update to the Required Prior Authorization List of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items That Require Prior Authorization as a Condition of Payment.”
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.
