Today, the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) joined 61 bipartisan senators and 233 members of the House of Representatives in urging the U.S. Department of Health and Human Services and Centers for Medicare & Medicaid Services (CMS) to swiftly finalize rules to extend transparency, streamline and standardize prior authorization (PA), including modifying the ultimate rules to more closely align with the Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173) by:

• Establishing a mechanism for real-time PA decisions for routinely approved services;
• Requiring Medicare Advantage plans to reply to PA requests for urgently needed care inside 24 hours; and
• Requiring Medicare Advantage plans to report detailed transparency metrics related to delays, denials, appeals, etc.

The letters were spearheaded by Senators Sherrod Brown (D-Ohio), John Thune (R-S.D.), Kyrsten Sinema (I-Ariz.) and Roger Marshall, MD (R-Kan.) within the Senate and Reps. Suzan DelBene (D-Wash.), Mike Kelly (R-Pa.), Ami Bera, MD, (D-Calif.) and Larry Bucshon, MD, (R-Ind.) within the House.

Aligning the regulations with this laws would protect patients in Medicare Advantage from unnecessary prior authorization practices that limit their timely access to medically mandatory care. Last 12 months, the Improving Seniors’ Timely Access to Care Act -; endorsed by greater than 500 state and national organizations representing patients, health care providers, and the medical technology and biopharmaceutical industry -; garnered 380 combined co-sponsors and unanimously passed the House of Representatives.

Our message to policymakers is easy: our patients cannot afford to attend or jump through unnecessary hoops to get look after painful, debilitating and life-threatening neurologic conditions. When finalized, these rules would remove barriers to patients’ timely access to care and permit physicians to spend more time treating patients and fewer time on paperwork.”

Russell R. Lonser MD, FAANS, chair of the department of neurosurgery at The Ohio State University and chair of the AANS/CNS Washington Committee

On April 5, CMS released one other final rule -; which matches into effect on Jan. 1, 2024 -; to enhance prior authorization within the Medicare Advantage program by ensuring:

• Prior authorizations remain valid through your entire course of treatment and for a 90-day transition if a patient changes plans;
• Medicare Advantage plans follow national and native Medicare coverage policies; and
• Plans don’t deny coverage of pre-authorized services.

Source:

American Association of Neurological Surgeons