AHA calls for prior authorization quality measures for Medicare Advantage plans

The Centers for Medicare & Medicaid Services should develop prior authorization measures for the Medicare Advantage Star Ratings Program to minimize care delays and protect patients from inappropriate care denials, AHA said in comments submitted today. “When instituted appropriately, prior authorization can help align patient care with health plan benefits and facilitates compliance with clinical best practices,” AHA wrote. “However, prior authorization requirements and processes vary widely, even among different health plan products offered by the same issuer, and can create dangerous delays in care delivery when not applied appropriately. They also can create confusion and burden for both patients and providers, leading to additional administrative costs for the health care system.”