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What We’re Reading: New Prior Authorization Limits; Veteran Suicide Prevention Program; AI Skin Cancer Detector
CMS has announced new federal rules that require health insurers to streamline requests to cover treatments; nearly 50,000 veterans used the emergency suicide prevention program launched by the Department of Veteran Affairs in 2023; the FDA recently authorized the first artificial intelligence (AI)-powered medical device to help doctors detect the most common forms of skin cancer.
New Prior Authorization Limits Considered Good First Step
CMS has announced new federal rules that address prior authorization (PA), requiring health insurers to streamline requests to cover treatments, according to Axios. Under these new rules, health insurers have to provide coverage decisions on urgent treatment requests for patients in Medicare Advantage, Medicaid, or Affordable Care Act plans within 72 hours; the deadline is 7 days for nonurgent requests. Also, insurers will be required to disclose PA denial rates, provide more specific denial justifications, and meet new technical standards to streamline the process. Insurers’ PA requirements have recently faced criticism, as they delay patients’ access to care. These new protocols, which largely take effect in 2026, will cut the review process in half for some insurers.
First-Year Veteran Suicide Prevention Program Sees High Usage
Nearly 50,000 veterans used the emergency suicide prevention program launched by the Department of Veteran Affairs (VA) last year, according to The Hill. The VA announced Wednesday that 49,714 veterans took advantage of the program, which allowed those experiencing an acute suicidal crisis to go to any VA or non-VA health facility to receive free emergency care, including emergency department visits, up to 30 days of inpatient or crisis residential care, and up to 90 days of outpatient care and transportation costs. Along with offering potentially life-saving care, the VA noted that the program saved more than $64 million in health care costs.
FDA Authorizes Device to Identify Suspicious Moles
The FDA recently authorized the first artificial intelligence (AI)-powered medical device to help doctors detect the most common forms of skin cancer in patients, according to CBS News. The DermaSensor, a noninvasive handheld device, further evaluates lesions that doctors flag as suspicious. The device uses AI-powered spectroscopy technology to assess cellular and below-the-surface characteristics of lesions, and provides real-time results based on an AI algorithm trained on data from more than 4000 malignant and benign lesions. The DermaSensor delivers a “spectral similarity score” for a patient’s mole or lesion by comparing it with known cases, complementing a physician’s assessment. The FDA noted that the device should only be used on patients aged 40 and up.
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
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Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
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