WEDI Provides Comments on CMS Proposed Rule on Prior Authorization and Attachments

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HHS advisor offers leadership and support for proposed rule that expands upon the 2020 CMS Interoperability and Patient Access final rule

"This proposed rule expands upon the CMS Interoperability and Patient Access final rule published on May 1, 2020, which WEDI generally supported, and emphasizes improving health information exchange for patients, providers, and payers to have access to complete health records."

WEDI, the nation’s leading nonprofit authority on the use of health IT to create efficiencies in health care information exchange and a statutory advisor to the U.S. Department of Health and Human Services (HHS), today issued a statement on behalf of its President and CEO, Charles Stellar. The following remarks are in response to the proposed rule by Centers for Medicare & Medicaid Services’ (CMS) on improving the electronic exchange of health care data among payers, providers and patients, and streamlining processes related to prior authorization (PA):

“This proposed rule expands upon the CMS Interoperability and Patient Access final rule published on May 1, 2020, which WEDI generally supported, and emphasizes improving health information exchange for patients, providers, and payers to have access to complete health records. At the same time, it proposes improvements to PA processes with the goal of reducing burden and keeping patients at the center of their own care.

“WEDI offers its leadership and support for this proposed rule, as we continue to work together alongside CMS. We applaud the work by CMS to improve health information exchange and reduce administrative burden on all stakeholders. WEDI’s mission and work are driven by easing administrative burden, putting patients at the center of their care, implementing consensusbased, mature standards that support automation, and maintaining appropriate safeguards for privacy, security, and confidentiality.”

WEDI’s comments are based on key guiding principles that are integral and essential considerations of any proposed rule provisions, specifically:

  • Meeting the goals of this proposed rule requires that relevant stakeholders have ready access to several key capabilities and functions. Providers must know whether payers require PA for a service along with the required information needed by the payer for the authorization. It is important to focus first on making these criteria as widely available and useful as possible, even if multiple approaches may be necessary.
  • It is important to design a transition to both promote seamless, automated data exchange through mature, clear, and unambiguous standards that have been thoroughly tested and demonstrate meaningful return on investment (ROI) and integrate the data exchange easily within the provider and other end-users’ workflows.

WEDI’s complete recommendations, which were submitted via the Federal Regulations Web Portal, http://www.regulations.gov/, can be found on the WEDI website.

About WEDI
WEDI is the leading authority on the use of health IT to improve health care information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s health care system. WEDI was formed in 1991 by the Secretary of Health and Human Services and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit http://www.wedi.org and connect with us on Twitter and LinkedIn.

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Tom Testa
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