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AAMC Responds to ONC RFI on Electronic Prior Authorization

March 25, 2022

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CONTACTS
Phoebe Ramsey, Manager of Regulatory Payment Policy & Quality
For Media Inquiries

The AAMC submitted comments on March 25 to the Office of the National Coordinator for Health Information Technology (ONC) in response to a request for information (RFI) on electronic prior authorization standards, implementation specifications, and certification criteria.

The AAMC has previously commented on the many challenges associated with prior authorization, including delays in medically necessary care and administrative burden [refer to Washington Highlights, January 8, 2021]. The letter to the ONC reiterated those concerns with prior authorization and highlighted a belief that electronic health record (EHR) systems could be better leveraged to automate and streamline prior authorization to improve patient care and reduce provider burden. However, the letter noted that “improving prior authorization requires broad adoption of national standards by payers and cannot be shouldered by providers alone” through new requirements for certified EHR technology. The letter urged the ONC to work with the Centers for Medicare & Medicaid Services (CMS) to both test technologies and workflows and establish requirements for CMS-regulated payers to meet quality and timeliness standards for electronic prior authorization processing.

The comments also responded to questions regarding impacts of electronic prior authorization on standards for patients and providers. For patients, the letter highlighted evidence suggesting that improving prior authorization processing could improve the timeliness of care and patient adherence to care plans. The AAMC’s letter emphasized that meaningful burden reduction is incentive enough for providers to implement electronic prior authorization standards, though the significant upfront investment will improve care delivery only so long as payers broadly adopt policies to streamline processing and approving prior authorization requests.

Responses to the RFI will be used to inform potential future rulemaking by the ONC.

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