NCQA Comments on CMS Proposed Prior Authorization Rule

Read NCQA’s full comments to CMS on the proposed Prior Authorization Rule 

"Current prior authorization policies suffer from many of the same challenges as quality measures that we are working to address by moving to digital quality measures (dQM). They are based on administrative data and guidelines and there is a broad desire to align them more closely with clinical best practices and treatment guidelines. They also are similar to payer-driven quality and value-based payment programs in that they are a huge source of administrative burden on providers, interrupt physician workflows and negatively impact patient experience.

The same arguments, approaches and standards for clinical reasoning and data collection for dQM can and should apply to digitizing prior authorization. Common approaches across plans and products, common mechanisms for sharing and validating data, and common infrastructure for running authorization guideline logic at the point of care make sense. Establishing common tools, infrastructure, standards, and implementation in this way is an important step to relieve prior authorization burden and allow for quicker response time decisions on prior authorization from payers to better meet patient needs." 

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