American College of Rheumatology issues recommendations for CMS on prior authorization

The American College of Rheumatology sent a letter to CMS Administrator Chiquita Brooks-LaSure commending her for the agency's recognition of the 2023 prior authorization proposed rule and issuing recommendations.

The March 13 letter speaks to the effect prior authorization has on patients with rheumatic diseases, arguing that timely care is essential to suppressing inflammatory conditions, keeping them in remission and improving quality of life.

"Unfortunately, rheumatology providers, sometimes successfully and sometimes not, are forced to overcome barriers every day in an attempt to prevent delays in the initiation and maintenance of treatment caused by prior authorization," the letter said.

The letter recommends CMS:

  1. Shorten the decision time to 24 hours for urgent requests.
  2. Include therapeutics in prior authorization policies and issue additional sub-regulatory guidance on step-therapy policies.
  3. Expand prior authorization guidance to include policies for all utilization management tools for services and therapeutics.
  4. Maintain the requirement in the proposed rule that payers must provide the reason for prior authorization denials.
  5. Exclude e-prior authorization measures for MIPS-eligible providers under the performance improvement category until electronic health records are able to report this measure without added burden to providers.

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