capitol hill report: CONFRONTING PRIOR AUTHORIZATION BURDEN, END OF PHE

February 6, 2023

Latest Advocacy News

• On January 30, the Biden administration announced a formal wind down of the COVID-19 Public Health Emergency (PHE). According to this announcement, the PHE is set to terminate on May 11, 2023. The AAN has been working continuously to ensure that access to neurology services is not disrupted upon the termination of the PHE declaration. Recently, in alignment with AAN advocacy, Congress extended Medicare telehealth flexibilities, including audio-only services, for two years, through December 31, 2024. The AAN will continue its efforts to ensure a smooth transition upon the termination of the PHE. The AAN is working to develop and disseminate resources so that AAN members can better understand the implications of the termination of the PHE both for their practice and for their patients.
• On January 25, the AAN submitted comments to the Centers for Medicare & Medicaid Services (CMS) calling on the agency to permanently add several codes to the Medicare Telehealth list to promote patient access to remote stroke care. The AAN’s comments also raised awareness of emerging evidence relating to remote programming analysis of deep brain stimulation data.
• On February 2, the AAN sent a letter to the Coverage and Analysis Group (CAG) at CMS requesting that the agency reconsider the National Coverage Determination (NCD) that restricts coverage of monoclonal antibodies directed against amyloid for the treatment of Alzheimer's Disease. The AAN believes that the phase III data from the CLARITY AD trial published in the New England Journal of Medicine indicating a direct clinical benefit warrants a focused expedited reconsideration of the existing coverage policy as it applies to lecanemab, as it would have been impossible for CMS to consider this highly relevant data at the time that the NCD was published. Read more about lecanemab and the work the AAN has been doing.
• The AAN provided support for the re-introduction of the Protecting Students from Concussions Act. This legislation would involve concussion action plans that include concussion education and required evaluation by a medical professional before students can return to play.

Issue in Focus

Reducing the administrative burdens faced by neurologists is a long-standing priority for the AAN. The AAN works to address administrative burdens across multiple fronts to ensure that clinicians can spend more time on patient care and less on administrative tasks. Prior authorization (PA) in particular is often cited as a top concern among AAN members. PA is one of the most time-consuming and expensive administrative requirements preventing physicians from spending more time with patients. Over 90 percent of clinicians reported that PA requirements have a negative impact on patient clinical outcomes and 82 percent of clinicians reported that issues associated with PA can lead to patients abandoning a recommended course of treatment. A recent member survey indicated that AAN members believe addressing administrative burden associated with PA should be the AAN’s top priority for 2023.

On January 30, the AAN submitted comments to CMS urging the agency to implement a number of critical reforms to improve oversight of Medicare Advantage (MA) plans’ usage of PA. These comments are a critical element in several years of efforts to pressure CMS to address the growing PA burden in MA. The AAN was deeply disturbed by April 2022 findings from the Department of Health and Human Services Office of Inspector General relating to inappropriate PA denials which found that some PA requests were denied by MA plans, even though the requested services met Medicare coverage guidelines The AAN strongly believes that Medicare beneficiaries enrolled in MA plans have the same access to covered services as those covered under Medicare Fee-for-Service. Key reforms contained in this proposed rule include: strengthening of evidentiary standards plans must use when developing PA policies, requiring greater alignment of MA PA policies with those in Medicare FFS, restrictions on the use of PA when patients transition between plans, and changes impacting reviewers of adverse decisions.

The AAN will continue its efforts to reduce PA-related burden and is currently working to draft additional comments to CMS in support of proposals advancing interoperability and improving the electronic exchange of health care data to streamline prior authorization processes. The AAN recognizes the importance of codification in legislation of important policies that prevent overly burdensome barriers to care. Last Congress, the Improving Seniors Timely Access to Care was one of the most widely supported bills, with 327 House and 53 Senate co-sponsors. The bill is likely to be reintroduced this Congress, pending reevaluation of the cost estimate from the Congressional Budget Office. AAN staff are keeping a close eye on this and other key legislative developments related to prior authorization.

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