AMRPA Access


AMRPA Announces Prior Authorization Data Collection Effort

By AMRPA Headquarters posted 07-06-2021 11:13


Cuzzola.jpgBy Anthony Cuzzola, AMRPA Board Chair

AMRPA’s advocacy efforts have continued at an active pace over the first half of 2021, despite the ongoing challenges that COVID-19 has presented to our field. Among our top priorities for 2021 is to work to curtail prior authorization practices by Medicare Advantage plans that delay or deny access to needed IRF care. The AMRPA policy team and members like yourself have engaged in dozens of meetings on Capitol Hill in support of legislation that would take important steps to mandate more oversight of prior authorization. AMRPA has also held multiple meetings with CMS officials this year to draw attention to current practices and the resulting harm to patients that hospital administrators like myself become far too familiar with.

As the next step in these efforts, AMRPA has announced it will be orchestrating a data collection effort during the month of August, and we are asking all AMRPA members and IRF hospitals to participate. This project will be vital to ensuring our field can provide meaningful data to policymakers about the experiences of our hospitals when it comes to prior authorization. The survey will ask hospitals to capture seven data points on the rate of affirmative and negative authorization decisions, and the timeliness of receiving these decisions. The data collection period will run from August 1-31, 2021, and additional information is available on the AMRPA website.

I’ve heard from other hospitals across the country about the increasingly prevalent delays and erroneous denials experienced by patients through prior authorization. Many of these patients are among the most vulnerable patient types – such as spinal cord injury, stroke, amputees and others – and are badly in need of the specialized care and rehabilitation services provided by IRFs. The stress placed on our healthcare system by COVID-19 made these delays and denials all the more harmful. However, COVID-19 also presented unique opportunities, such as the voluntary waivers of prior authorization in the early stages of the pandemic, which demonstrated how admissions could function without these barriers in place. It is our belief that by combining our ongoing efforts with the additional data this survey will provide, we can continue to make progress in minimizing the number of patients that are wrongly denied needed care.

As we move forward with the second half of 2021, I want to thank all of you for the contributions you have made to date by sharing your valuable time with AMRPA. Your participation on AMRPA committees, Congressional visits, educational webinars and conferences, and other events is what allows our Association to continue to advance the field of medical rehabilitation and serve our communities in the best way possible.

If you have any questions about this or other efforts, or would like to become more involved, please reach out to the AMRPA staff who will be happy to speak with you.