The U.S. Centers for Medicare & Medicaid Services has proposed new requirements that would ease some of the administrative burdens of prior authorization across a range of federal programs including Medicare Advantage, state Medicaid and Children's Health Insurance Program fee-for-service plans, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan issuers in the federal ACA insurance exchange. Those changes, if adopted, would make life easier for providers, including PTs, almost immediately after their 2024 startup date.
But it’s broader than that. The proposed rules provide several opportunities for a more expansive conversation around prior authorization, transparency, and other aspects of administrative burden. That's yet another reason why it's crucial for APTA members and supporters to send comment letters to CMS by March 13.
Here are five ways the proposed rules — and even the comment process — could help the profession gain ground in other longer-term, big picture areas.