Advocacy News

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The Centers for Medicare & Medicaid Services finalized a rule to reform prior authorization use in Medicare Advantage plans last week, advancing one of the Academy’s top advocacy priorities. Here is our analysis on how the rule will affect your practices.

The Academy and an ophthalmology coalition met with Aetna leaders to discuss the payer’s decision to maintain its Medicare Advantage prior authorization requirement for all cataract procedures in Florida, after recently discontinuing the same program in Georgia.

The rule makes important changes to the prior authorization process that align with the Academy’s priorities of reducing administrative burdens on practices and allowing patients more timely access to the care they need. 

In the first step in a renewed effort to end cataract prior authorization requirements for Medicare Advantage patients in Florida, the Academy and our coalition partners demanded data from Aetna to back up its rationale for maintaining the policy in a single state. Florida members: Join us by sharing your stories with the Academy.

Advocacy works. Aetna has confirmed that starting Jan. 1, it will stop requiring prior authorization for cataract surgeries in Georgia.

With a growing number of Medicare and Medicaid beneficiaries enrolled in managed care arrangements, the Department of Health and Human Services Office of Inspector General plans to scrutinize the programs to address waste, fraud and abuse.

In a win for patients, Humana announced it will stop requiring prior authorization for cataract and YAG surgery for Medicare Advantage members in Georgia, effective Aug. 1.

Members reported to the Academy and ASOPRS that prior authorization requests have been denied for medically necessary injections into the brow and corrugator/procerus muscles to treat blepharospasm.

Florida and Georgia state societies joined the Academy in driving home the burdens of prior authorization.