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What We’re Reading: CMS Proposes Interoperability Rule; FDA Report Urges Major Changes; AMA, IHI Form Coalition


CMS proposed a rule to streamline the prior authorization process and expand health information access; a scathing report urged the FDA to consider restructuring and potentially dividing the agency; the Institute for Healthcare Improvement (IHI) and American Medical Association (AMA) are coleading the Rise to Health Coalition.

Proposed CMS Rule Improves Prior Authorization Process, Health Information Access

Under a new rule proposed by CMS, the agency will establish policies to make the prior authorization process more efficient and transparent, according to a CMS press release. Certain payers will also be required to implement an electronic prior authorization process, shorten time frames to respond to requests, and set standards to enable data exchange from one payer to another when a patient changes payers or has concurrent coverage. These requirements would generally apply to Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program (CHIP) agencies, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan issuers on the federally facilitated exchanges. CMS estimates these streamlined processes would save physician practices and hospitals over $15 billion in a decade. AHIP has shown support of the new interoperability rule, which is available for review and comments until March 13, 2023.

Review Urges Potential Division of FDA

A scathing report of the FDA by the Reagan-Udall Foundation was conducted in the wake of the infant formula crisis this year, and it urges the FDA to consider restructuring and potentially divide the agency so oversight of the food system gets more attention. As reported by The Washington Post, the task force’s first suggestion was to create separate food and drug administrations within HHS, requiring approval from Congress. Acknowledging the severity of this suggestion, the task force’s smaller suggestions included separating the food and drug arms but keeping them within a single agency, and creating a new deputy commissioner position with authority for overseeing food systems.

AMA, IHI Form Rise to Health Coalition to Beat Health Care Bias, Inequity

The Institute for Healthcare Improvement (IHI) announced the launch of a new national coalition on health equity co-ed by the American Medical Association (AMA) on Tuesday, Modern Healthcare reported. The Rise to Health Coalition will bring together hundreds of health systems, companies, and organizations to develop a cohesive approach to more equitable patient care and remove areas of inequity and bias. The coalition will also include individual providers, insurance companies, professional societies, and pharmaceutical, research, and biotech organizations to share solutions and take collective action.

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