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As of February 9, 2020, there are 4958 open recommendations, of which 422 are priority recommendations. Recommendations remain open until they are designated as Closed-implemented or Closed-not implemented.
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Recommendation: The Administrator of CMS should take steps, based on results from evaluations, to continue prior authorization. These steps could include: (1) resuming the paused home health services demonstration; (2) extending current demonstrations; or, (3) identifying new opportunities for expanding prior authorization to additional items and services with high unnecessary utilization and high improper payment rates. (Recommendation 2)
Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services Status: Open Priority recommendation
Comments: In August 2018, the Department of Health and Human Services reported that it concurs with this recommendation. CMS has recently taken steps to evaluate its prior authorization programs. In May 2018, CMS announced it was revising the home health services demonstration, which it paused in April 2017. The demonstration had not resumed as of January 2019. In June 2018, CMS added 31 new items to its required prior authorization list for the permanent durable medical equipment, prosthetics, orthotics, and supplies prior authorization program, effective September 2018. In June 2018, CMS issued an interim report on the independent evaluation of the non-emergency hyperbaric oxygen therapy demonstration, and a CMS official reported that the agency would release a final report at a later date. In November 2018, CMS extended the repetitive scheduled non-emergency ambulance service demonstration for 1 year, through November 2019. GAO will continue to monitor issued agency guidance on the home health services demonstration and to evaluate additional steps CMS takes to continue prior authorization in Medicare, such as identifying new opportunities for prior authorization.