ASTRO backed proposed reforms to Medicare Advantage plans use of prior authorization in a letter to the Centers for Medicare and Medicaid Services (CMS) sent. February 13.  The letter supports CMS’ proposals to establish standards for prior authorization and improving health equity, including:

• Preventing MA plans from retroactively denying services after prior authorization approval.
• Preventing MA plans from denying coverage for services otherwise covered under traditional Medicare.
• Requiring MA organizations to incorporate at least one activity that is designed to reduce disparities in health into their existing quality improvement (QI) programs.

ASTRO also signed onto an American Medical Association-led physician group letter and a cancer patient advocate letter from the Cancer Leadership Council.

What’s Next: We are hopeful that CMS will finalize the provisions in this proposed rule. The agency released an additional proposed rule focused on advancing interoperability and improving prior authorization processes for both Medicare and Medicaid programs. Comments are due March 13 and ASTRO will be submitting a comment letter in support.