The American Academy of Sleep Medicine (AASM) recognizes the increasing administrative burden and costs associated with prior authorization, for both individual and facility members. In order to address these concerns, the AASM is increasing advocacy efforts to reduce the harms and burdens associated with prior authorization through increased communication with the Centers for Medicare and Medicaid Services (CMS) and support of proposed legislation.

On June 6, CMS released a request for information to seek public input on the Patients over Paperwork initiative, aimed at further reducing administrative and regulatory burden to lower health care costs. CMS noted that it was seeking innovative ideas for potential solutions to relieve burdens and ways to improve documentation, policies, and program requirements.

The AASM submitted a response to the RFI, highlighting the administrative burdens associated with prior authorization in sleep medicine. The response letter also referenced best practices for prior authorization, developed by an American Medical Association (AMA) workgroup. Recognizing that CMS has become increasingly reliant on automation, the AASM also included comments referencing the impact of electronic health records (EHRs) on physician burnout. To further emphasize the challenges faced by providers, AASM recently signed on to an AMA letter, expressing strong concerns that CMS may be focusing on automation as the only vehicle for implementing prior authorization reforms.

The AASM is also advocating for changes to prior authorization requirements through legislation. Representatives Suzan DelBene (D-WA), Mike Kelly (R-PA), Roger Marshall, MD (R-KS) and Ami Bera, MD (D-CA) recently introduced H.R. 3107, the Improving Seniors’ Timely Access to Care Act, which would streamline and standardize prior authorization under the Medicare Advantage program. The AASM signed on to an AMA letter of support for the legislation.