AHA, AMA, BCBSA Urge CMS Not to Adopt Proposed Standards for Healthcare Attachments
The HHS’ Centers for Medicare and Medicaid Services (CMS) is being urged not to implement the proposed standards for prior authorization attachments, as detailed in its December 2022 Notice of Proposed Rulemaking (NPR). In a letter to CMS Administrator, Chiquita Brooks-LaSure, the American Hospital Association (AHA), American Medical Association (AMA), and Blue Cross Blue Shield Association (BCBSA) applauded the CMS for its focus on reforming prior authorization to ensure timely access to care for patients while minimizing manual paperwork for all healthcare stakeholders, but expressed their concern that the proposed changes would likely cause widespread industry confusion, be enormously expensive, and would create the same costly burdens that the proposed standards seek to alleviate.
“First, major efforts are underway to automate PA-related data exchange leveraging Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) implementation guides,” explained the trade groups in the letter. “Secondly, and even more significantly, the Advancing Interoperability and Improving Prior Authorization NPRM (CMS-0057-P) would require federally regulated health plans to offer HL7 FHIR-based application programming interfaces to support electronic PA information exchange. In contrast, the attachments NPRM would require a combination of both X12 and HL7 standards and apply to all health plans under the Health Insurance Portability and Accountability Act (HIPAA) regulatory pathway.”
The NPRMs would create conflicting provisions and would establish two different sets of standards and workflows to complete the prior authorization process and federally regulated health plans would be required to crosswalk the two standards for no discernible benefit. That would directly counter the foundational principles of the original HIPAA administrative simplification regulations, which require the adoption of uniform electronic standards to support communication between providers and all health plans. As such, the AHA, AMA, and BCBSA strongly advise against the adoption of the standards for prior authorization attachments.
