Biden admin appears to withdraw final rule aimed at streamlining prior authorization

The Biden administration appears to have withdrawn a rule finalized last minute by the Trump administration that aims to streamline prior authorization, a major source of provider administrative burden.

The Centers for Medicare & Medicaid Services (CMS) released the final rule Jan. 15, touting it as an easy way for patients to get their healthcare data.

Former CMS Administrator Seema Verma said in a press release at the time that millions of “patients will no longer have to wrangle with prior providers or locate ancient fax machines to take possession of their data.”

But that press release no longer appears on CMS’ website, and the rule does not appear in the Federal Register.

CMS did not say why the rule appeared to be withdrawn.

“This matter is currently under CMS review and we look forward to sharing additional information about this program soon,” an agency spokesperson said.

The White House did issue a memo shortly after Biden was inaugurated Jan. 20 calling for a freeze on any last-minute regulations finalized by his predecessor.

RELATED: AMA pushes for federal intervention to reform prior authorization

If a rule had been sent to the Federal Register but had not been published yet, it must be immediately withdrawn, the memo said.

CMS did not say that the withdrawal was due to the memo and refused to comment on what other rules could be affected by the freeze.

The rule could still survive, as any regulations affected by the freeze must be reviewed and approved by an agency or department head.

The final rule called for payers in Medicaid and the Children’s Health Insurance Program fee-for-service programs, managed care plans and issuers of qualified health plans on the individual market to build application programming interfaces to facilitate data exchange and prior authorization.

Affected plans also would have had to meet reduced timelines on whether to approve prior authorization requests. Payers must make a decision within 72 hours for any urgent requests and seven calendar days for non-urgent requests.

The payers must also put a specific reason for any denial starting Jan. 1, 2024, according to the rule.

The rule addresses a source of major administrative burden for physicians and providers. A 2017 survey from the American Medical Association found 84% of those surveyed described prior authorization as a high burden.

But the rule got a sharp rebuke from America’s Health Insurance Plans, the insurance industry’s top lobbying group.

“This shabbily and hastily constructed rule puts a plane in the air before the wings are bolted on by requiring health insurance providers to build these technologies with incomplete and untested instruction manuals,” said the group's CEO Matt Eyles in a statement last month.

Eyles also slammed the hasty nature of the rule's approval, noting stakeholders only had 14 days to comment on the rule—and then the comments were processed and reviewed within just nine days.

He called it the “shortest rulemaking process on a major healthcare rule that anyone can remember.”