Back to archive page
CHA News

CHA Submits Comments on Prior Authorization, 1135 Waiver Process Proposals

For CEOs, CFOs, finance & reimbursement staff, government relations staff

CHA recently submitted comments on a proposed rule by the Centers for Medicare & Medicaid Services (CMS) – in coordination with the Office of the National Coordinator for Health Information Technology – intended to streamline and reduce the burden associated with health plan prior authorization processes through Application Programming Interfaces (APIs).  

CHA supported a number of proposals, including requirements for impacted payers to implement a Prior Authorization Support API to facilitate a HIPAA-compliant prior authorization request and response, and requirements that plans provide a specific reason a prior authorization request is denied. However, CHA urged CMS to apply its proposals to Medicare Advantage plans in the final rule.  

CHA also submitted comments on CMS’ proposal to establish an automated process for submitting 1135 waiver requests. CHA supports the creation of a public-facing web form to facilitate the required data collection and reduce the burden for hospitals that need to request 1135 waivers.  

CMS also proposed a second public-facing web form to support nationwide reporting about the operational status of health care providers and their beneficiaries impacted by emergencies and disasters directly to CMS. While CHA understands this form would reduce burden for CMS, we urged the agency to ensure hospitals are not required to respond to multiple data requests during disasters or emergencies.