AMRPA Access


Prior Authorization & the Pandemic

By AMRPA Headquarters posted 02-08-2021 13:43

xqOD10pSQG9LiWKNnLu4_temp-T.jpgBy Jonathan Gold, JD
Director of AMRPA Government Relations and Regulatory Counsel

AMRPA is aware of the cumbersome nature of prior authorization requirements for IRF admissions, as well as the detriment that these care delays and denials have on patients. Due to this, reforms to prior authorization practices have become central to AMRPA’s advocacy efforts on the federal level. More recently, the Association has been closely monitoring the impact prior authorization has had on hospitals’ ability to meet the needs of patients in their communities during the COVID-19 Public Health Emergency (PHE).

In the course of AMRPA’s ongoing engagement with Centers for Medicare and Medicaid (CMS) officials, AMRPA has raised the urgent need for the agency to take steps to halt prior authorization requirements for hospital admissions during the PHE. While some plans voluntarily suspended these practices early-on in the pandemic, it is our understanding most have resumed their usual practices. CMS personnel have expressed a desire to learn of specific cases of care delays and disruptions being caused by prior authorization, and how these delays are hampering the ability of providers to respond to COVID-19.

AMRPA is therefore asking any providers with specific and recent examples of prior authorization slowing the movement of patients through sites of care, or otherwise impeding access to needed post-acute care during the COVID-19 pandemic, to contact AMRPA staff. We would like to discuss with you potentially bringing these cases to CMS to demonstrate the need for a policy adjustment as the pandemic continues to impact communities. All information will be held in confidence by AMRPA until we discuss and receive approval to share the information provided by your hospital.

In addition to prior authorization, AMRPA staff also continues to monitor for other developments and circumstances that may necessitate further policy action by CMS. If you or your hospital have other concerns about COVID-19 waivers or operations that you would like to discuss with AMRPA, do not hesitate to contact us about that as well.