ONC Calls for Input on Electronic Prior Authorization Data Standards

ONC has released a Request for Information (RFI) seeking public input on electronic prior authorization data standards, implementation specifications, and certification criteria that could be adopted for the ONC Health IT Certification Program.  

ONC may use RFI responses to inform potential future rulemaking to support electronic prior authorization. Such electronic processes will ease administrative burden on patients, providers, and payers, officials said.

Payers establish prior authorization requirements to help control costs by verifying that an item or service is necessary, meets coverage criteria, and is consistent with standards of care. However, healthcare stakeholders have frequently noted that prior authorization process is laden with administrative burden for patients, providers, and payers.

Varied payer policies, workflow challenges, and technical barriers around prior authorization processes contribute to clinician burnout, ONC officials said. They also pointed out that prior authorization can delay patient care, which may put patient safety at risk.

ONC is requesting public comment on how the Certification Program can build on existing efforts to reduce the burden of prior authorization. ONC is also requesting input on anticipated benefits and burdens of any updates to the Certification Program for patients, providers, or health IT developers.

“Supporting the needs of clinicians and improving patient care are key priorities for ONC,” Elise Sweeney Anthony, executive director of the Office of Policy, said in a press release.

“We’re eager to hear from the public about prior authorization and ways to bridge the gap between administrative and clinical data so that clinicians have more time to focus on patient care and patients have a better experience with the healthcare system,” she added.

This RFI builds on several previous ONC efforts to address prior authorization burden concerns. ONC’s February 2020 report, “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs,” identified specific challenges associated with the prior authorization process.

The report outlined a set of recommendations for improved prior authorization, including leveraging health IT to standardize data and processes around ordering services or equipment; coordinating efforts to advance data standards; and incentivizing adoption of technology that can generate and exchange standardized data for documentation needs.

Additionally, the Intersection of Clinical and Administrative Data Task Force (ICAD) of the Health Information Technology Advisory Committee (HITAC) provided a report and set of recommendations to the HITAC in November 2020. The report focused on improving data interoperability by establishing standards for prior authorization workflows.

“We support efforts that can serve to advance electronic prior authorization for patients, providers, and payers,” noted Mary Greene, MD, director of the CMS Office of Burden Reduction and Health Informatics. “We look forward to reviewing the input received on this RFI and to exploring opportunities for alignment between future ONC policymaking and ongoing CMS initiatives on this critical topic.” 

Stakeholders must submit comments by March 25, 2022, ONC officials noted.