Obama Budget Seeks Prior-Authorization Ability For All Medicare Fee-For-Service Items
This article was originally published in The Gray Sheet
The administration’s March 4 budget request, repeats past attempts to expand prior-authorization requirements for power wheelchairs and advanced imaging, while also giving CMS the authority to institute prior-authorization for all Medicare fee-for-service items.
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The agency is proposing to pre-authorization rules for certain durable medical equipment and an expansion of the power mobility equipment prior-authorization pilot program, and the creation of new pilot prior-authorization programs for hyperbaric oxygen therapy and repetitive scheduled non-emergent ambulance transport.
The Senate Finance Committee and House Ways & Means Committee circulated a discussion draft to replace the maligned Medicare sustainable growth rate formula for physician pay with a system that freezes base payments but offers value-based incentives. The bill also calls for mandatory use of appropriateness criteria for advanced imaging and electrocardiogram, and prior authorization in some cases.
House Speaker Boehner and Senate Majority Leader McConnell “respectfully decline” the president’s request to submit names of individuals to serve on the Medicare Independent Payment Advisory Board.