Simplifying and Standardizing Prior Authorization for Medicare Advantage Services.
This law aims to speed up access to expensive medical services and drugs for Medicare Advantage enrollees by reforming the prior authorization process. It mandates an audit to identify and standardize overly complex authorization requirements for the highest-cost covered items. Furthermore, doctors in high-performing Accountable Care Organizations (ACOs) may be exempt from these requirements, potentially accelerating patient treatment.
Key points
Prior Authorization Reform: The government must audit and standardize complex prior authorization steps for the top 10% highest-reimbursed medical services and drugs in Medicare Advantage.
Faster Treatment Access: Doctors within successful Accountable Care Organizations (ACOs) can bypass prior authorization for these specific services, reducing waiting times for patients.
Standardization focuses only on specific high-cost items that meet criteria for excessive complexity and sufficient clinical evidence.
Expired
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