ALS United Connecticut Applauds Long-Awaited Victory for ALS Community as CMS Implements Groundbreaking Prior Authorization Reforms

January 2024

The Centers for Medicare and Medicaid Services (CMS) have unveiled a final rule that marks a decisive stance against hindering essential medical care through the misuse of prior authorization by health insurance providers.

Starting in 2026, the new rule mandates Medicare Advantage (MA) plans to respond to urgent prior authorization requests from doctors within a swift 72-hour window, while standard requests must be addressed within seven (7) days. This significant development will help alleviate the burdensome delays that people living with ALS face in obtaining crucial care, including access to vital medical equipment and supportive services.

ALS United CT expressed gratitude for the relentless efforts of CMS in championing these transformative reforms. Amy Chickles, Director of Programs said, “People living with ALS don’t have time to wait for critically important medical equipment. These reforms address the unacceptable situation where individuals with ALS suffer needlessly during prolonged appeals to health insurers for rejected claims.”

The new rule will compel insurers to provide specific reasons for denials, facilitating smoother claim resubmissions and appeal processes. Insurers will also be mandated to publicly report prior authorization metrics and adopt an electronic prior authorization system, contributing to a more efficient healthcare ecosystem.

CMS anticipates that these policies will streamline prior authorization processes, reducing the burden on patients, providers, and payers, with an estimated savings of approximately $15 billion over the next ten years. For more information, read the CMS Press Release.