NCMS Morning Rounds 1-20-21

Already Wednesday and time for your NCMS Morning Rounds.

Jan. 20, 2021

CMS Finalizes New Prior Authorization Rule

Last week the Centers for Medicare and Medicaid Services (CMS) finalized a rule that gives physicians and PAs access to patient treatment histories and streamlines prior authorization to help alleviate what is often a burden for health care providers and patients.

Changes include allowing certain payers, providers and patients to have electronic access to pending and active prior authorization decisions, which should result in fewer repeated requests for prior authorizations, reducing costs and onerous administrative burden to our frontline providers.

The “CMS Interoperability and Prior Authorization” rule requires payers regulated under Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs and issuers of individual market Qualified Health Plans on the Federally-facilitated exchanges to implement application programing interfaces (APIs) that will give providers better access to data about their patients, and streamline the process of prior authorization. APIs are the foundation of smartphone applications, and when integrated with a provider’s electronic health record (EHR), they can enable data access at the touch of a button. With this technology, patients have easier access to their own health information, their providers have a more complete picture of their care, and patients can take their information with them as they move from plan to plan, and from provider to provider throughout the health care system.

These payers are also required to share this data directly with patients’ providers if they ask for it and with other payers as the patient moves from one payer to another. These payers will now have a maximum of 72 hours to make prior authorization decisions on urgent requests and seven calendar days for non-urgent requests, and all payers subject to the rule are required to provide a specific reason for any denial, which will allow providers some transparency into the process beginning Jan. 1, 2024.

Read the rule here.

Information and Resources on Expanding Access to Naloxone in NC

A recent Centers for Disease Control and Prevention (CDC) advisory on the increasing number of drug overdose deaths recommended increased access to naloxone as one way to curb this trend. Last month, Injury-Free NC presented an informative webinar on how to expand access to naloxone in the state.

Recently, Injury-Free NC hosted a webinar on expanding naloxone access in North Carolina. View the webinar recording here to learn more about the fundamentals of naloxone distribution, examples of community-based distribution, partnerships to expand naloxone distribution such as working with local law enforcement, and options for purchasing naloxone.

North Carolina has been a national leader in community distribution of naloxone–most notably through the work of the North Carolina Harm Reduction Coalition. As of January 2019, the NCHRC had distributed over 101,000 free naloxone kits and received 13,394 reports of successful administration of naloxone by laypersons. North Carolina has also been the first state to have an EMS naloxone leave-behind program, whereby EMS personnel give persons who decline transport to the hospital after an overdose a free naloxone kit.

Learn more and access a toolkit here that helps organizations understand the laws and logistics implicated in naloxone distribution in an effort to further promote community distribution of naloxone in North Carolina.

Behavioral Health Professionals – Your Input is Needed

If you are a behavioral health professional (e.g. social worker, psychiatrist, psychologist, therapist, psychiatric nurse or psychiatric nurse practitioner) who works with youth, please consider participating in a study focusing on workplace policies and their relationship to provider LGBTQ+ Cultural Competency (UVA IRB SBS #4042).

Your individual responses will be kept confidential, and only group data will be reported. The survey should take less than 15 minutes to complete.

Access the consent form and survey here. Questions may be directed to Grace Leffler at the University of Virginia at


In the News

Mayo, Epic and Cerner Teaming to Create Digital COVID-19 Vaccine Passport, Healthcare Dive, 1-15-21

Learning Opportunity

2021 NC Dermatology Association VIRTUAL Annual Meeting (Jan. 30-31, 2021). The North Carolina Dermatology Association, an NCMS-managed specialty society, is pleased to announce its 2021 Annual Meeting will be held virtually for the very first time. The program will feature outstanding faculty who will address current topics of interest to the practicing dermatologist and dermatopathologist. This year’s program includes presentations on pyoderma gangrenosum, coding updates, and hemangiomas and hyperhidrosis, in addition to clinical presentations and an important advocacy update. The schedule includes daily breaks and a networking hub presenting products and services to help the dermatology practice.

Learn more here. Register here.

If you have policies you’d like your NCMS Board of Directors to consider, please complete the Board input form here. Thanks for reading!



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