NEWSWIRE


region. lobally, deaths from road traffi c inuries are  percent male. In the mericas, drug use has emerged as


a signifi cant contributor to both disability and death. There was a nearly threefold increase in deaths from drug use disorders in the mericas between 2000 and 2019. This region is also the only one for which drug use disorder is a top 10 contributor to healthy life-years lost due to premature deaths and disability, while in all other regions, drug use does not make the top 2.


CMS proposes new rules to address prior authorization and reduce burden The Centers for Medicare  Medicaid ervices (CM) issued a proposed rule that would improve the electronic exchange of healthcare data among payers, providers, and patients, and streamline processes related to prior authoriation to reduce burden on providers and patients. y both increasing data  ow, and reduc- ing burden, this proposed rule would give


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providers more time to focus on their patients and provide better quality care. The proposed rule aims to improve this for patients navigating care. The proposed rule would build on the Interoperability and Patient ccess fi nal rule published by the CMS in May.


The rule would require payers in


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Medicaid, CIP and P programs to build application programming inter- faces (PIs) to support data exchange and prior authorization. APIs allow two systems, or a payer’s system and a third- party app, to communicate and share data electronically. Payers would be required to implement and maintain these APIs using the ealth evel  () ast ealthcare Interoperability esources (I) standard. The I standard is an innovative technology solution that helps bridge the gaps between systems so both systems can understand and use the data they exchange. Prior authorization is an administrative process used in healthcare for providers to request approval from payers to provide a medical service, prescription, or supply. This process takes place before a service is rendered. The rule proposes signifi cant changes to improve the patient experience and alleviate some of the administra- tive burden prior authoriation causes healthcare providers. Medicaid, CIP and P payers would be required to build and implement I-enabled PIs that could allow providers to know in advance what documentation would be needed for each different health insur- ance payer, streamline the documentation process, and enable providers to send prior authoriation requests and receive responses electronically, directly from the providers  or other practice manage- ment system. hile Medicare dvantage plans are not included in todays propos- als, CM is considering whether to do so in future rulemaking. The proposed rule would also reduce the amount of time providers wait to receive prior authoriation decisions from payersthe rule proposes a maximum of 2 hours for payers, with the excep- tion of P issuers on the s, to issue decisions on urgent requests and seven calendar days for non-urgent requests. Payers would also be required to provide a specifi c reason for any denial, which will allow providers some transparency into the process. To promote account- ability for plans, the rule also requires them to make public certain metrics that demonstrate how many procedures they are authorizing. HPN


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