Georgia Legislators Urge CMS Review of Prior Authorizations for Cataract Surgery

Federal legislators from Georgia, in a letter (PDF) led by Rep. Buddy Carter, R-Ga., have asked the Centers for Medicare & Medicaid Services (CMS) to investigate ongoing prior authorization requirements for some Georgia cataract surgeries.

The group of Republicans asked CMS Administrator Chiquita Brooks-LaSure to “ensure that Georgia Medicare beneficiaries’ access to medically necessary cataract surgery is not improperly delayed or denied.” Republican Reps. Barry Loudermilk, Rick Allen and Drew Ferguson also joined the call for scrutiny.

Aetna rescinded a nationwide approval requirement as of July 1, except for Florida and Georgia Medicare Advantage patients. Humana began requiring prior authorizations for some Georgia cataract surgeries Aug. 1, also limited to only Medicare Advantage patients.

Reducing administrative burdens is one of the Academy’s top advocacy priorities. We believe medically necessary surgeries should not be delayed by prior authorization and such a requirement for routine cataract surgery is an abuse of the tool.

During the year of Aetna’s national cataract policy, we heard many stories about the ways prior authorizations delayed timely treatment and interfered with clinical decision-making. If you’ve experienced any issues in Georgia or Florida related to this policy let us know.

The Academy continues to challenge these policies in Georgia and Florida, but we need your help to strengthen our efforts.

You can help us better communicate how these policies are harming patients and practices by filling in this form and telling us about your experience. You can also support OPHTHPAC^®, the Academy's pro-ophthalmology, nonpartisan political action committee.