Will CMS Crack Down on Prior Authorization?

Doctors and patients in the US are frustrated with the prior authorization process required by health insurance companies. Medicare Advantage insurers had to process an average of 1.5 prior authorization requests per patient in 2021. Legislation to regulate prior authorization has strong support from lawmakers, but a bill has not yet passed Congress. The Centers for Medicare & Medicaid Services is considering a rule that would standardize the prior authorization process. The American Hospital Association has urged CMS to act quickly, and patients are still dealing with delays and appeals in the prior authorization process. The proposed federal reforms would not apply to veterans or those covered by private, employer-sponsored plans.

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