Academy Advocacy Win: CMS Releases Prior Authorization Rule for Medicare Advantage Plans

December 13, 2022

AAPM&R is excited to share that on December 6, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining improvements to prior authorization processes for Medicare Advantage (MA) plans.  Prior authorization reform has been and continues to be a top advocacy priority for AAPM&R, particularly MA prior authorization which is a major source of burden for physiatrists.  If adopted, the rule will require MA plans to adopt electronic prior authorization, improve response times, and streamline and simplify their processes.  This rule documents CMS efforts to reduce administrative burden and ensure patients’ timely access to care. 

Your Academy is in the process of reviewing the rule in detail and will be sending feedback directly to CMS.  In preliminary review, we are pleased to see the proposed rule is consistent with the legislation for improving prior authorization, Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173), which your Academy has been strongly advocating for in partnership with the Regulatory Relief Coalition. 

Following years of Academy advocacy, Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173) passed the U.S. House of Representatives in September.  The new CMS proposed rule creates potential for a reduced score from the Congressional Budget Office (CBO), which could improve the chances of this legislation passing the Senate this year.  Many Senators have already shown support for S. 3018 by co-sponsoring the legislation. Please contact your Senator today via our Member Action Center.  If you have any questions, please contact Academy staff at healthpolicy@aapmr.org.  Thank you for being a #PMRAdvocate!