Health groups ask CMS for prior authorization relief during COVID-19 pandemic

The American College of Cardiology, American College of Surgeons and other leading healthcare societies have penned a letter to CMS Administrator Seema Verma asking for Medicare Advantage plans to waive prior authorization requirements during the ongoing COVID-19 pandemic.

The change, the groups explained, would speed up patient care at a time when health systems are overworked and every second is especially valuable. Prior authorization requirements consume “considerable resources” and have a negative impact on “non-coronavirus related cases that are, by definition, urgent.”

“Per CMS’ recommendation, elective surgeries are now being done mostly outpatient or postponed,” according to the letter. “Only triaged, unavoidable surgeries are being done in the inpatient setting. As these inpatient settings are increasingly crowded with patients fighting the COVID-19 virus, patients who are awaiting life-saving surgeries are not only at a higher the risk of infection but are also taking up valuable ICU bed space. Removing barriers to patients receiving their surgeries and treatment in an expeditious fashion is more important now, than ever before.”

The groups also emphasized that CMS has granted waivers to numerous state Medicaid plans to wave prior authorization requirements during this challenging time. A similar update for Medicare Advantage plans, they noted, would help “physicians, nurses and other clinical staff” spend their time treating the most urgent patients.

The letter, available to read here, was signed by the American Academy of Neurology, American Academy of Ophthalmology, American Association of Neurological Surgeons, American Association of Orthopaedic Surgeons, American College of Rheumatology, American Gastroenterological Association, American Urological Association, Association for Clinical Oncology, Congress of Neurological Surgeons, National Association of Spine Specialists, and Society for Cardiovascular Angiography and Interventions.