In response to prior authorization adjustments proposed by the Facilities for Medicare and Medicaid Providers (CMS) in a proposed rule for contract 12 months 2026 adjustments to the Medicare Benefit Program, the AASM submitted feedback to CMS supporting prior authorization reform.
These proposed adjustments purpose to enhance transparency and cut back administrative burdens related to prior authorization. AASM helps CMS’s proposal to introduce separated prior authorization metrics, which might assist determine inefficiencies in utilization administration insurance policies. Given the vital function of well timed prognosis and remedy for sleep problems similar to obstructive sleep apnea, AASM urged additional reforms to make sure that sufferers obtain mandatory care with out pointless delays.
Key areas of enchancment embody:
Decreasing administrative burdens
Streamlining approvals for routine diagnostic testing
Exempting high-risk sufferers from prior authorization necessities
Standardized prior authorization standards throughout payers
AASM stays dedicated to advocating for insurance policies that improve affected person entry to sleep drugs providers and cut back boundaries to important care. Please ship questions relating to AASM help for prior authorization reform to coding@aasm.org.
