NAMD Comments on Proposed Interoperability and Prior Authorization Rule

CMS recently issued a proposed rule, Advancing Interoperability and Improving Prior Authorization, that would extend the Patient Access API to include prior authorization information and require Medicaid agencies to implement new Provider Access, Payer-to-Payer, and Prior Authorization Requirements, Documentation, and Decision APIs. The rule would also create new timeframes for prior authorization decisions.

Although Medicaid agencies support CMS’ aim of streamlining access to health care information, they report concerns about the feasibility of implementing three new APIs and significantly changing prior authorization operations, given existing bandwidth challenges and competing priorities. To address these concerns, CMS should:

• Extend the implementation deadline for the proposed APIs and prior authorization timeframes to at least January 1, 2027
• Allow Medicaid agencies to apply for two one-year extensions for implementation
• Provide Medicaid agencies with significant technical assistance, including technical specifications

You can read our full comments here.