Neurosurgeons call on CMS to finalize prior authorization rules


The American Association of Neurological Surgeons and Congress of Neurological Surgeons called on the U.S. Department of Health and Human Services and CMS to finalize prior authorization rules to increase transparency and streamline the process.

The organizations joined 61 senators and 233 members of the House of Representatives June 21, urging the government to update CMS' final rules to align with the Improving Seniors' Timely Access to Care Act, according to a news release from the AANS. That act aims to establish better transparency metrics for delays, denials and appeals; implement a mechanism for real-time prior authorization decisions for common services, and require Medicare Advantage plans to respond to requests for "urgently needed" care within 24 hours.

"Our message to policymakers is simple: Our patients cannot afford to wait or jump through unnecessary hoops to get care for painful, debilitating and life-threatening neurologic conditions," Russell Lonser, MD, chair of the AANS/CNS Washington Committee, said in the release. "When finalized, these rules would remove barriers to patients' timely access to care and allow physicians to spend more time treating patients and less time on paperwork."

In April, CMS released a final rule going into effect Jan. 1, 2024, that will improve prior authorization. The rule ensures that prior authorizations stay valid through the course of patient treatment, that CMS plans follow national and local Medicare policies, and that plans don't deny coverage of pre-authorized services.

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