CMS Responds to ASCP, AMA Concerns on Prior Authorization

March 03, 2020

On February 21, the Centers for Medicare and Medicaid Services (CMS) responded to a letter from ASCP and the AMA raising concern that the Agency is overly focused on automation as a means to implement prior authorization policy changes. ASCP, the AMA, and other medical specialty groups wrote to CMS on September 20, 2019 about its plans for the Di Vinci Project, which the Agency is pushing as a means facilitate the electronic exchange of clinical data extracted from physician electronic health records (EHRs). Our letter noted that the Di Vinci project could lead to payers inappropriately access patient health care information, leverage the Project to prompt greater use of the system by physicians, and interfere in medical decision making. While automation is key to prior authorization reform, ASCP and others urged for a broader range of policy responses to address needed prior authorization reforms. In response, CMS acknowledged our concerns and responded in part, stating that technological solutions “would have to ensure the integrity of these systems and that electronic data transfers only permit access to certain defined data elements.” While CMS outlined its interest in working with stakeholders on the implementation of the Di Vinci Project, ASCP is concerned that the Agency’s response does not signal any plans for a broader array of solutions to reform the prior authorization process. ASCP will continue to urge for more meaningful reforms that help minimize the burden on healthcare providers and patients.

Other articles in the March 2020 ePolicy News:

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For more information regarding ASCP's advocacy initiatives and policy positions, please contact ASCP's Center for Public Policy at (202) 408-1110.

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