AHA pushes CMS to delay Medicare prior authorization pilot

The American Hospital Association is urging CMS to delay its Medicare prior authorization pilot — the Wasteful and Inappropriate Service Reduction initiative — by at least six months.

“This timeframe is impractical for providers and jeopardizes the administration’s goal of easing provider administrative burden associated with prior authorization,” the organization said in an Oct. 23 letter to CMS. The model is currently slated to launch in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma Jan. 1, 2026.

The AHA advocated for several changes to be made to the program, such as using a flat-fee model instead of a vendor payment structure that “incentivizes denials at the expense of physician medical judgment.” 

Along with that change, the group pushed for a more robust appeals process, guardrails on AI use, consistency with prior authorization reform technology, clear identification of how the pilot will be assessed and greater vendor oversight. The AHA also expressed concerns over the program’s scope, regarding both the services subject to prior authorization and the states in which the initiative is being implemented.

This article was originally published on Becker’s.