ONC wants feedback on electronic prior authorization standards

The Health and Human Services Department wants to know what providers and other stakeholders think about electronic prior authorization, the Office of the National Coordinator for Health Information Technology announced Friday.

ONC released a request for information on how its Health IT Certification Program can incorporate standards, implementation specifications and certification criteria to advance electronic prior authorization.

“Supporting the needs of clinicians and improving patient care are key priorities for ONC,” Elise Sweeney Anthony, executive director of the agency’s Office of Policy, said in a news release. “We’re eager to hear from the public about prior authorization and ways to bridge the gap between administrative and clinical data so that clinicians have more time to focus on patient care and patients have a better experience with the healthcare system.”

Prior authorization policies require providers to get approval from payers before prescribing medications, performing procedures or delivering other services. Health insurers say these policies help control costs and reduce unnecessary services, while clinicians and patients express frustration with the administrative burden and with care delays that prior authorization can cause.

HHS has encouraged providers to submit prior authorization requests electronically, but even though adoption has increased over time, just 21% of health plans accepted digital inquiries in 2020, a CAQH survey found. Fully transitioning to electronic prior authorization would save $417 million a year, the health insurance industry group projects.

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The Centers for Medicare and Medicaid Services published a proposed rule in December 2020 that would have required Medicaid and Children’s Health Insurance Program managed-care plans, state Medicaid and CHIP agencies, and health insurance exchange plans to streamline the prior authorization process.

A proposed rule on the HHS regulatory agenda for this year would require Medicaid, CHIP, exchange plans and Medicare Advantage carriers to improve electronic exchanges of healthcare data and to simplify prior authorization.

ONC requests feedback on a core set of capabilities that would enable certified systems to identify when prior authorization is applicable, collect necessary documents, receive payer responses and other functions. ONC also wants comments on whether the Fast Healthcare Interoperability Resources (FHIR) implementation guides proposed in a previous rule are appropriate.

Additionally, ONC asks stakeholders how potential changes to the certification program could impact patients, reduce burden for providers, place new demands on health IT developers and more.

The agency is accepting submissions until March 25.