Tuesday, May 27, 2014

CMS Expanding Several Prior Authorization Programs

Dan Ciolek

On May 22, the Centers for Medicare and Medicaid Services announced an expansion of their prior authorization program in a press release titled “Prior Authorization to Ensure Beneficiary Access and Help Reduce Improper Payments.”  The activities that may impact beneficiaries include:
  1. Expansion of successful demonstration for prior authorization for power mobility devices from the current 7 states (CA, FL, IL, MI, NY, NC, and TX) to an additional 12 states (AZ, GA, IN, KY, LA, MD, MO, NJ, OH, PA, TN, and WA). More info here
  2. Begin demonstrations testing of prior authorization for additional services in two areas:
    1. non-emergent hyperbaric oxygen therapy and 
    2. repetitive scheduled non-emergent ambulance transport.
  3. Proposal to begin prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies. The proposed rule is currently on display and will be published in the Federal Register on May 28, 2014. The deadline to submit comments is July 28, 2014. More info here
CMS claims that prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments. The proposed rule is estimated to reduce Medicare spending by $100 to $740 million over the next ten years.

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