ANCOR Advocates for Increased Transparency and Efficiency in Health Care Prior Authorization Process for People with I/DD

The Centers for Medicare and Medicaid Services (CMS) on Advancing Interoperability and Improving Prior Authorization Processes. The rule aims to promote greater transparency and efficiency in the prior authorization process for health care providers, including community-based providers who support people with intellectual and developmental disabilities (I/DD).

ANCOR has offered comments on the proposed rule, with a focus on the impact on community-based providers and the individuals who leverage their services and supports. ANCOR’s comments support the requirement for states to provide clear and expedited responses to prior authorization requests. Additionally, ANCOR supports the publication of annual reports identifying denial trends and disparities in impact to help address issues of inequity in the system.

Prior authorization is a process used by health insurers to determine whether a treatment or service is medically necessary before it can be approved and paid for. However, the process can be time-consuming and burdensome for health care providers, including community-based providers who support people with I/DD. The proposed rule aims to address these issues and promote greater transparency and efficiency in the prior authorization process.

ANCOR’s comments highlight the importance of ensuring that the prior authorization process does not become a barrier to accessing necessary services and supports. By requiring states to provide clear and expedited responses to prior authorization requests, people with I/DD and their providers will be better equipped to navigate the system and receive the support they need.