Prior authorization reporting

We want to make sure that everyone gets the same quality of health care, no matter who they are or where they come from. To help do this, the Centers for Medicare & Medicaid Services (CMS) is gathering data from health plans about how people are treated when they need prior authorization (approval for certain medical services).

By studying this data, we can find out if some people are not getting the right care because of their social or health conditions and help make sure that everyone gets fair treatment.

You can view the report that Fallon Health provided to CMS below:

• Annual Health Equity Analysis of UM Policies and Procedures - Medicare 2024

* This report represents the results of the CMS-required assessment of the impact of prior authorization on members who are defined as being potentially impacted by health equity inequalities versus those who are not defined as having health equity inequalities (as defined by CMS). The comparison shows no differential impact of prior authorization on members defined as being affected by health equity inequalities.