AASM comments on CMS prior authorization rule

DARIEN, Ill. – The American Academy of Sleep Medicine (AASM) has submitted comments to the Centers for Medicare & Medicaid Services (CMS) supporting efforts to improve interoperability and digitize prior authorization through standardized electronic processes. CMS published the Interoperability Standards and Prior Authorization for Drugs Proposed Rule in April. AASM says electronic prior authorization and application programming interface-based data exchange have the potential to reduce care delays, improve workflow efficiency and enhance care coordination for patients requiring sleep testing, positive airway pressure therapy, medications and other sleep-related interventions. At the same time, AASM urged CMS to make sure the requirements are feasible for specialty practices, including small or resource-constrained sleep medicine practices. Key recommendations from AASM include:

• Expansion of electronic prior authorization for drugs across both medical and pharmacy benefits to reduce fragmented, manual processes
• Clear and consistent decision timeframes, including expedited pathways for clinically urgent therapies, such as treatments for narcolepsy and hypersomnia
• Greater transparency in denials, with specific explanations tied to clinical criteria and documentation requirements
• Public reporting of prior authorization metrics to improve accountability across payers
• Support for the exchange of clinically relevant sleep data, including polysomnography reports, home sleep apnea test results, PAP adherence data and validated questionnaires, through standardized APIs

AASM says successful implementation will depend on making interoperability and prior authorization reforms technologically robust, clinically practical and aligned with specialty care workflows.