Dear Administrator Verma,
We write to you to express bipartisan concern over a proposal by the Centers for Medicare and Medicaid
Services (CMS) to expand prior authorization for certain items and services in the calendar year (CY) 2021
Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC)
Payment System. If finalized, we believe this policy could negatively impact beneficiary access to medically
necessary procedures, and we ask you to reconsider.
Prior authorization is an important cost utilization management tool in our current fee-for-service landscape
and should be reserved for situations in which over-utilization has been demonstrated. However, through this
proposed rule, CMS is moving toward broader use of prior authorization. In the CY 2021 proposed rule,
CMS intends to implement prior authorization for two new service categories for the hospital outpatient
department (HOPD) beginning on dates of service on or after July 1, 2021. The two new service categories
proposed are implanted spinal neurostimulators and cervical fusion with disc removal. This follows
implementation of prior authorization for five HOPD service categories on July 1, 2020.
Read full letter here
