The American Hospital Association (AHA) has submitted recommendations to the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). The aim is to ensure that insurance plans comply with a pledge by these agencies to reform prior authorization processes.
The AHA's suggestions include monitoring the progress of insurance plans in implementing existing regulations. These regulations encompass the interoperability and prior authorization final rule, as well as reforms outlined in the 2024 Medicare Advantage final rule. The AHA emphasized the significant negative impact that certain prior authorization practices have on patients, physicians, and hospitals.
"As a result of the enormous detrimental impact that certain prior authorization practices routinely place on patients, physicians and hospitals, the AHA has been actively pushing for reforms in this area for a long time and working with health plans to collaboratively reduce the burdens associated with these programs," said the AHA.
For more information about CMS regulations, visit https://www.cms.gov/regulations-and-guidance/regulations-and-policies/electronic-standards/interoperability.
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