CMS adds 29 organizations to ePA

The Centers for Medicare & Medicaid Services said on May 13 that 29 healthcare organizations had joined a new electronic prior authorization acceleration initiative, adding hospitals, physician groups, health IT vendors and data networks to a federal push that had previously centered on insurers. The agency said the effort is meant to address workflow and technical gaps before key federal interoperability requirements take effect in 2027. The new participants include Epic, Oracle, athenahealth and Cleveland Clinic, alongside nine payers that had already signed a separate pledge with CMS. The move expands CMS’s attempt to turn prior authorization from a manual, fax-heavy process into a standardized digital workflow. ### Which organizations did CMS add this week? CMS named 29 organizations as early adopters in the new phase of the initiative, including providers such as Cleveland Clinic, Providence, Ochsner Health, Rush University System for Health and Tennessee Oncology. The list also includes electronic health record vendors athenahealth, eClinicalWorks, Epic, MEDITECH, Modernizing Medicine and Oracle, plus networks including CommonWell, eHealth Exchange and Kno2. (cms.gov) Nine insurers were already part of the broader CMS effort, according to the agency, including Aetna, Cigna, Elevance, Highmark, Humana and UnitedHealthcare. CMS said the new cohort joins those payers in working on “workflow, technical, and operational barriers” that have slowed adoption of electronic prior authorization across the healthcare system. (cms.gov) ### Why is CMS pushing this now instead of waiting for the rule to kick in? The 2024 CMS Interoperability and Prior Authorization final rule set new requirements for certain payers to support electronic prior authorization for medical items and services. CMS said impacted payers must meet some provisions by January 1, 2026, but have until primarily January 1, 2027, to meet the application programming interface requirements tied to prior authorization. (cms.gov) CMS Administrator Dr. Mehmet Oz said in the May 13 release that prior authorization “won’t be fixed by technology alone” and requires organizations across the healthcare system to work together on “real-world challenges.” CMS said the acceleration initiative is intended to support readiness ahead of the 2027 deadline rather than replace the rule. (cms.gov) ### What problem is the agency trying to solve? CMS said providers spend an average of 13 hours a week requesting prior authorizations, at an estimated cost of $20 to $50 per hour. On an annual basis, the agency said that amounts to roughly $34,000 and 700 hours of administrative time per provider. The 2024 final rule requires API-enabled data exchange using FHIR-based standards, defined timeframes for prior authorization decisions and public reporting of prior authorization metrics, according to CMS. (cms.gov) The agency has framed those changes as a way to reduce provider burden and speed access to care. ### Are physicians convinced these voluntary efforts will change much? (cms.gov) The American Medical Association said on May 13 that only 33% of physicians surveyed believed the latest insurer pledge on prior authorization would make a meaningful difference. The AMA surveyed 1,000 practicing physicians ahead of the first major deadlines tied to a 2025 insurer pledge to streamline and reduce prior authorization requirements. (cms.gov) AMA President Bobby Mukkamala said physician trust in voluntary insurer pledges was “deeply eroded” after years of unfulfilled promises. The group said 24% of physicians reported that medical necessity denials were consistently reviewed by an appropriately qualified clinician, while 95% said prior authorization delays necessary care and 79% said patients abandon treatment because of authorization challenges. (ama-assn.org) ### What changes in 2027 if the initiative works as CMS intends? Starting January 1, 2027, certain CMS-regulated health plans must implement and maintain prior authorization APIs as part of the broader interoperability rule, according to the agency. CMS is also urging providers and vendors to begin testing electronic prior authorization workflows now, and its electronic prior authorization page says organizations should prepare to start submitting requests electronically in 2027. (ama-assn.org) CMS’s public early-adopter page lists the participating providers, vendors, networks and payers, and the agency said the work will continue through the Health Tech Ecosystem initiative as the 2027 deadline approaches. (cms.gov 1) (cms.gov 2)