March 28, 2022

On March 25, APMA responded to the Office of the National Coordinator for Health Information Technology’s (ONC) Request for Information: Electronic Prior Authorization Standards, Implementation Specifications, and Certification Criteria. In APMA’s comments, we expressed substantial support for the ultimate end goals of the proposed standards—namely, decreased burden on clinicians and quicker access to care for patients. However, APMA also expressed significant concerns about how these changes would impact providers in the short term and the likelihood of payers increasing the numbers of services and goods that require prior authorization, in bad faith. APMA also made some of the following recommendations:

• Work with all impacted stakeholder groups and related agencies, including the Centers for Medicare and Medicaid Services (CMS), to develop clear standards and processes that are rigorously tested prior to widespread implementation
• Require that “peer-to peer” reviews are done by physicians in the same specialty as the ordering physician
• Require payers to adopt transparent prior authorization programs that are reviewed annually, adhere to evidence-based medical guidelines, and include continuity of care for individuals transitioning between coverage policies to minimize any disruption in care.

To read the letter in full, visit www.apma.org/commentletters. Members can also access the full archive of comment letters on this page. If you have questions and concerns, contact the APMA Health Policy and Practice department at healthpolicy.hpp@apma.org. 

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