In response to prior authorization changes proposed by the Centers for Medicare and Medicaid Services (CMS) in a proposed rule for contract year 2026 changes to the Medicare Advantage Program, the AASM submitted comments to CMS supporting prior authorization reform.
These proposed changes aim to improve transparency and reduce administrative burdens associated with prior authorization. AASM supports CMS’s proposal to introduce separated prior authorization metrics, which could help identify inefficiencies in utilization management policies. Given the critical role of timely diagnosis and treatment for sleep disorders such as obstructive sleep apnea, AASM urged further reforms to ensure that patients receive necessary care without unnecessary delays.
Key areas of improvement include:
- Reducing administrative burdens
- Streamlining approvals for routine diagnostic testing
- Exempting high-risk patients from prior authorization requirements
- Standardized prior authorization criteria across payers
AASM remains committed to advocating for policies that enhance patient access to sleep medicine services and reduce barriers to essential care. Please send questions regarding AASM support for prior authorization reform to coding@aasm.org.
