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Exam Code: CAP Certified Authorization Professional health January 2024 by team

CAP Certified Authorization Professional

Exam Title :
ISC2 Certified Authorization Professional (CAP)

Exam ID :

Exam Duration :
180 mins

Questions in Exam :

Passing Score :

Exam Center :
Pearson VUE

Real Questions :
ISC2 CAP Real Questions

VCE Practice Test :
ISC2 CAP Certification VCE Practice Test

Information Security Risk Management Program (15%)

Understand the Foundation of an Organization-Wide Information Security Risk Management Program

- Principles of information security

- National Institute of Standards and Technology (NIST) Risk Management Framework (RMF)

- RMF and System Development Life Cycle (SDLC) integration

- Information System (IS) boundary requirements

- Approaches to security control allocation

- Roles and responsibilities in the authorization process

Understand Risk Management Program Processes

- Enterprise program management controls

- Privacy requirements

- Third-party hosted Information Systems (IS)

Understand Regulatory and Legal Requirements

- Federal information security requirements

- Relevant privacy legislation

- Other applicable security-related mandates

Categorization of Information Systems (IS) (13%)

Define the Information System (IS)

- Identify the boundary of the Information System (IS)

- Describe the architecture

- Describe Information System (IS) purpose and functionality

Determine Categorization of the Information System (IS)

- Identify the information types processed, stored, or transmitted by the Information System (IS)

- Determine the impact level on confidentiality, integrity, and availability for each information type

- Determine Information System (IS) categorization and document results

Selection of Security Controls (13%)

Identify and Document Baseline and Inherited Controls

Select and Tailor Security Controls

- Determine applicability of recommended baseline

- Determine appropriate use of overlays

- Document applicability of security controls

Develop Security Control Monitoring Strategy

Review and Approve Security Plan (SP)

Implementation of Security Controls (15%)

Implement Selected Security Controls

- Confirm that security controls are consistent with enterprise architecture

- Coordinate inherited controls implementation with common control providers

- Determine mandatory configuration settings and verify implementation (e.g., United States Government Configuration Baseline (USGCB), National Institute of Standards and Technology (NIST) checklists, Defense Information Systems Agency (DISA), Security Technical Implementation Guides (STIGs), Center for Internet Security (CIS) benchmarks)

- Determine compensating security controls

Document Security Control Implementation

- Capture planned inputs, expected behavior, and expected outputs of security controls

- Verify documented details are in line with the purpose, scope, and impact of the Information System (IS)

- Obtain implementation information from appropriate organization entities (e.g., physical security, personnel security

Assessment of Security Controls (14%)

Prepare for Security Control Assessment (SCA)

- Determine Security Control Assessor (SCA) requirements

- Establish objectives and scope

- Determine methods and level of effort

- Determine necessary resources and logistics

- Collect and review artifacts (e.g., previous assessments, system documentation, policies)

- Finalize Security Control Assessment (SCA) plan

Conduct Security Control Assessment (SCA)

- Assess security control using standard assessment methods

- Collect and inventory assessment evidence

Prepare Initial Security Assessment Report (SAR)

- Analyze assessment results and identify weaknesses

- Propose remediation actions

Review Interim Security Assessment Report (SAR) and Perform Initial Remediation Actions

- Determine initial risk responses

- Apply initial remediations

- Reassess and validate the remediated controls

Develop Final Security Assessment Report (SAR) and Optional Addendum

Authorization of Information Systems (IS) (14%)

Develop Plan of Action and Milestones (POAM)

- Analyze identified weaknesses or deficiencies

- Prioritize responses based on risk level

- Formulate remediation plans

- Identify resources required to remediate deficiencies

- Develop schedule for remediation activities

Assemble Security Authorization Package

- Compile required security documentation for Authorizing Official (AO)

Determine Information System (IS) Risk

- Evaluate Information System (IS) risk

- Determine risk response options (i.e., accept, avoid, transfer, mitigate, share)

Make Security Authorization Decision

- Determine terms of authorization

Continuous Monitoring (16%)

Determine Security Impact of Changes to Information Systems (IS) and Environment

- Understand configuration management processes

- Analyze risk due to proposed changes

- Validate that changes have been correctly implemented

Perform Ongoing Security Control Assessments (SCA)

- Determine specific monitoring tasks and frequency based on the agency’s strategy

- Perform security control assessments based on monitoring strategy

- Evaluate security status of common and hybrid controls and interconnections

Conduct Ongoing Remediation Actions (e.g., resulting from incidents, vulnerability scans, audits, vendor updates)

- Assess risk(s)

- Formulate remediation plan(s)

- Conduct remediation tasks

Update Documentation

- Determine which documents require updates based on results of the continuous monitoring process

Perform Periodic Security Status Reporting

- Determine reporting requirements

Perform Ongoing Information System (IS) Risk Acceptance

- Determine ongoing Information System (IS)

Decommission Information System (IS)

- Determine Information System (IS) decommissioning requirements

- Communicate decommissioning of Information System (IS)
Certified Authorization Professional
ISA Authorization health

Other ISA exams

CAP Certified Authorization Professional
ISA-IEC-62443 ISA/IEC 62443 Cybersecurity Fundamentals Specialist Certification

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Certified Authorization Professional
Question: 384
An authentication method uses smart cards as well as usernames and passwords for
authentication. Which of the following authentication methods is being referred to?
A. Anonymous
B. Multi-factor
C. Biometrics
D. Mutual
Answer: B
Question: 385
In 2003, NIST developed a new Certification & Accreditation (C&A) guideline known as FIPS
199. What levels of potential impact are defined by FIPS 199? Each correct answer represents a
complete solution. Choose all that apply.
A. Low
B. Moderate
C. High
D. Medium
Answer: A, C, D
Question: 386
Which of the following is NOT an objective of the security program?
A. Security organization
B. Security plan
C. Security education
D. Information classification
Answer: B
Question: 387
Walter is the project manager of a large construction project. He'll be working with several
vendors on the project. Vendors will be providing materials and labor for several parts of the
project. Some of the works in the project are very dangerous so Walter has implemented safety
requirements for all of the vendors and his own project team. Stakeholders for the project have
added new requirements, which have caused new risks in the project. A vendor has identified a
new risk that could affect the project if it comes into fruition. Walter agrees with the vendor and
has updated the risk register and created potential risk responses to mitigate the risk. What
should Walter also update in this scenario considering the risk event?
A. Project contractual relationship with the vendor
B. Project communications plan
C. Project management plan
D. Project scope statement
Answer: C
Question: 388
During which of the following processes, probability and impact matrix is prepared?
A. Plan Risk Responses
B. Perform Quantitative Risk Analysis
C. Perform Qualitative Risk Analysis
D. Monitoring and Control Risks
Answer: C
Question: 389
During qualitative risk analysis you want to define the risk urgency assessment. All of the
following are indicators of risk priority except for which one?
A. Symptoms
B. Cost of the project
C. Warning signs
D. Risk rating
Answer: B
Question: 390
Which of the following statements about Discretionary Access Control List (DACL) is true?
A. It is a rule list containing access control entries.
B. It specifies whether an audit activity should be performed when an object attempts to access a
C. It is a list containing user accounts, groups, and computers that are allowed (or denied) access
to the object.
D. It is a unique number that identifies a user, group, and computer account
Answer: C
Question: 391
Which of the following is used to indicate that the software has met a defined quality level and is
ready for mass distribution either by electronic means or by physical media?
Answer: B
Question: 392
Which of the following processes is a structured approach to transitioning individuals, teams,
and organizations from a current state to a desired future state?
A. Configuration management
B. Procurement management
C. Change management
D. Risk management
Answer: C
Question: 393
A security policy is an overall general statement produced by senior management that dictates
what role security plays within the organization. What are the different types of policies? Each
correct answer represents a complete solution. Choose all that apply.
A. Systematic
B. Regulatory
C. Advisory
D. Informative
Answer: B, C, D
Question: 394
Which of the following is a standard that sets basic requirements for assessing the effectiveness
of computer security controls built into a computer system?
Answer: A
Question: 395
Which of the following statements correctly describes DIACAP residual risk?
A. It is the remaining risk to the information system after risk palliation has occurred.
B. It is a process of security authorization.
C. It is the technical implementation of the security design.
D. It is used to validate the information system.
Answer: A
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ISA Authorization health - BingNews Search results ISA Authorization health - BingNews ISA Standards

Practical Solutions from Industry Experts

ISA standards help automation professionals streamline processes and improve safety, cybersecurity, and efficiency in operations spanning multiple industry segments. Over 150 consensus standards and guidelines reflect the work and knowledge of more than 3,000 participating experts worldwide.

What is a Standard?

A standard sets forth requirements that a process, system, product, or material must satisfy if it is to be truthfully stated (or advertised) as meeting that standard.

ISA standards are not government regulations, but rather are voluntary documents that are sometimes referenced in regulations. In addition, contracts between private entities may include requirements to follow specific ISA standards.

Among their many benefits, standards help manufacturing and related organizations by harnessing years of experience and expert knowledge to:

  • increase human safety,
  • improve communications,
  • reduce design and implementation costs,
  • enable component and systems interchangeability,
  • reduce downtime and maintenance costs, and the need to keep large inventories, and
  • protect the natural environment.

ISA also develops two types of informative documents that support the understanding and use of ISA standards—but that do not carry the normative standing of an ISA standard:

  • Recommended practices (RPs) embody guidelines that may be followed or adopted to work effectively in specific applications within the scope of an ISA standards committee;
  • Technical reports (TRs) set forth informative material and guidelines to help users understand and apply an existing standard, or to better understand a topic that is important within the scope of an ISA standards committee.

ISA Standards Participation is Open to Experts from Any Country

ISA is accredited by the American National Standards Institute (ANSI) to develop industry standards following approved processes to ensure openness and balance—and to prevent dominance by specific interests, companies, or organizations.

ANSI is a nonprofit organization, not a government agency. ANSI accreditation does not prevent participation in ISA standards by those outside the U.S. In fact, individuals working on ISA standards committees are based in more than 40 countries. Membership in ISA is not a requirement.

ISA Standards Committees

The key elements of ISA’s standards development program are set forth in our ANSI-accredited procedures. Those procedures call for main (oversight) committees that develop standards strictly within their approved scope areas to ensure that different committees do not work on the same or overlapping topic areas. Main committees typically have working groups that work on specific documents or projects.

ISA main standards committees include:

  • Instrumentation Symbols and Diagrams (ISA5)
  • Management of Alarms (ISA18)
  • Instrumented Systems to Achieve Functional Safety (ISA84)
  • Batch Process Control (ISA88)
  • Enterprise-Control System Integration (ISA95)
  • Industrial Automation and Control Systems Security (ISA99)
  • Wireless Systems for Automation (ISA100)
  • Human-Machine Interface (ISA101)
  • Procedure Automation for Continuous Process Operations (ISA106)
  • Intelligent Device Management (ISA108)
  • SCADA Systems (ISA112)
  • Fossil and Nuclear Power Plants (ISA77 and ISA67)
  • Control Valves (ISA75) and Valve Actuators (ISA96)

Serving on ISA Standards Committees

Participation on ISA standards committees is open at no cost to automation professionals from any country who agree to abide by each of the following requirements:

  1. To follow the ISA Standards Code of Conduct (see ANNEX A in our procedures).

  2. To understand you serve on an ISA standards committee strictly as an individual expert, not as a company or organizational representative.

  3. To never represent yourself in discussions, presentations, articles, or other communications as speaking for or on behalf of ISA or of a specific ISA standards committee or project without prior approval by ISA’s staff Director of Standards.

  4. To focus strictly on the technical content of standards, with no discussion or consideration of commercial/business issues in standards committee meetings or at any other time within the context of ISA standards development. This includes pricing of components or systems, sales information, market shares, warranties, and guarantees.

  5. To recognize and understand that ISA asserts ownership of all rights of copyright to its standards, including drafts, technical reports, recommended practices, and the completed, adopted standards for the convenience and benefit of all concerned. Specifically, ISA standards committee members:

  • must respect the intellectual property rights of others and must not knowingly provide or insert any copyrighted works into any committee materials for which the member has not received permission as necessary for use with the standard.
  • must not disclose any proprietary or confidential information in the course of ISA standards committee participation without authorization.
  • must agree to irrevocably transfer to ISA all right, title, and interest in and to any standard or other material developed under the auspices of ISA, including copyright, that such participant might otherwise acquire by law.

Voting and Nonvoting Members

ISA main committees include voting and nonvoting (also called information) members. The voting membership of main committees must be balanced across interest categories that include users, suppliers, integrators, consultants, government/regulators, and test/certification providers. This balance is intended to allow fair and open input from all categories without domination by any one category.

Voting members must meet active participation requirements (such as submitting content to documents) as defined by the main committees to qualify for and maintain their voting status. There may be no more than one voting member employed by the same company or organization.

New members to ISA standards committees typically join as information (nonvoting) members. Information members are observers who may submit review comments on documents and participate directly in committee work, including writing documents and leading working groups. They may apply for voting status if they can meet a committee-defined level of participation.

Working groups under a main committee may conduct informal votes on documents or other matters, but do not have official voting and nonvoting members.

Approving New or Revised ISA Standards

For details on how standards (as well as RPs and TRs) are approved by committees, see our procedures. To summarize:

  • Committee chairs approve the issue of a ballot on a standard, TR, or RP.
  • ISA standards are consensus documents, and thus unanimous approval by main committee voting members is not required.
  • For approval, standards require (a) a majority of the voting members to respond and (b) 2/3 approval of those voting members who responded.
  • TRs and RPs, being informative documents, require majority approval of the voting members.

All committee members, voting and nonvoting, may submit review comments during a ballot. All comments must be responded to in writing (typically in a spreadsheet) for viewing by the entire committee. Responses are usually prepared by the working group that developed the document.

Voting members are given a chance to change their votes based on the responses and any resulting changes to the document.

The process of voting, response, and reconsideration can sometimes go through several cycles, but when finished the document is balloted to a governing body, the ISA Standards & Practices Board, for final approval. This latter ballot is strictly to approve that ISA’s procedures have been followed properly in the development of the document. It is not a ballot on the technical content, which is solely the responsibility of the respective standards committee, being made up of technical experts.

Obtaining and Viewing ISA standards

ISA standards may be obtained at the listing of all ISA standards.

For ISA members, a major benefit of membership is free viewing of ISA-copyrighted standards, RPs, and TRs.

Do you have a suggestion for a new standard, topic, or training that ISA should consider? Please send it to ISA Standards.

Thu, 08 Jun 2023 19:30:00 -0500 en text/html
ISA Transactions: The Journal of Automation

ISA Transactions is a journal of advances and state-of-the-art in the science and engineering of measurement and automation, of value to leading-edge industrial practitioners and applied researchers.

The topics of measurement include: sensors, perception systems, analyzers, signal processing, filtering, data compression, data rectification, fault detection, inferential measurement, soft sensors, hardware interfacing, etc.; and any of the techniques that support them such as artificial intelligence, fuzzy logic, communication systems, and process analysis. The topics of automation include: statistical and deterministic strategies for discrete event and continuous process control, modelling and simulation, event triggers, scheduling and sequencing, system reliability, quality, maintenance, management, loss prevention, etc.; and any equipment, techniques and best practices that support them such as optimization, learning systems, strategy development, security, and human interfacing and training.

The intended audience is research and development personnel from academe and industry in the field of process instrumentation, systems, and automation.

The journal seeks to bridge the theory and practice gap. This balance of interests requires simplicity of technique, credible demonstration, fundamental grounding, and connectivity to the state of the art in both theory and practice.

Manuscript Types and Categories

We publish articles (primarily relating to research or to practice), letters, or errata.

  • Errata: These publications represent an authors' or editor's correction to an article.
  • Letters: Letters to the editor would be short, one-paragraph, or so, affirmations, questions, challenges, or answers to articles or letters.
  • Research Articles: These can be from either of the categories that follow, and will primarily relate to research, investigation, and to possibilities. Normally, they focus on the fundamental analysis or mathematics of a technique. Normally they are illustrated with simulations, and are written by and for those in research.
  • Practice Articles: These can be from either of the categories that follow, and will primarily relate to the practice or to applications. Normally, they focus on the pilot-scale or full-scale application and the heuristics and post implementation audit of an application. Normally they are concerned with application results and interpretation, and are written by and for those implementing measurement and control.

Articles (research or practice) may be from the following categories:

  • Analysis: Clearly develop a fundamental, mathematical analysis of a practice-relevant application or methodology. Explicitly state implications and recommendations for its application. Provide credible examples.
  • Design: Present a complete "how-to" guide. Connect design procedures to first principles. Explicitly state heuristics and limits of applicability. Provide evidence that the procedures are practicable.
  • Application: Present the results of new (or under-utilized) techniques or novel applications. Provide a complete description of results, including pilot- or plant-scale experimental data, and a revelation of heuristics and shortcomings.
  • Tutorial/Review: Present what might become a chapter in a text - a comprehensive exposition or survey of the analysis, design and application of a technique that is practice-important but not yet common textbook material. Include a critical review of the state of the art to guide practitioner choices.
  • Editorial: Present a balanced and learned perspective on the implications of historical trends or developing issues that reveal needs and direction for action or change. The concepts could be aimed at research, standards, products, criteria for evaluation, or organizations.
  • Technical Notes: Present new concepts or initial proof-of-concept results on innovative approaches. The manuscripts would be short, perhaps two journal pages, and would not require extensive comprehensive defence required of regular papers. However, they would be critically reviewed for compliance to ISA T Aims and Scope. Technical notes are intended to accelerate the dissemination of ideas, and will be given priority in the publication queue. The title must start with the identification "Technical Note:"

ISA Transactions is a monthly publication available online to ISA members and in print for Institutions.


ISA members have access to online PDF files to current and prior articles. Members activation link to ISA Transactions publication: Not a member? Join today.


For information on institutional subscriptions, both print and Science Direct, please contact Elsevier.

Wed, 26 Apr 2023 17:29:00 -0500 en text/html
Resurrecting ISA Hardware

[Alex] had an old FM radio tuner card come his way. It used an ISA connector, a standard that went the way of the dodo in the mid-nineties. With the challenge of implementing an ISA-bus to configure the card he set out on his mission. What he came up with is a working radio using the ISA card and driven by a PIC 16F877. Join us after the break for schematic, code, and a few details.

The card is based on an LM7000 PLL synthesizer paired with a LC7534 tone/volume controller. With a bit of datasheet study [Alex] figured out where the data pins for the chips map to the ISA bus. Working with a prototyping board, the hardest part turned out to be finding the addresses for the chips. He ended up testing all 256 possibilities and watching for the data to be latched from the ISA bus. Alex says the hardware is capable of tuning from about 60MHz up to 125MHz.

We asked him if he’d share his code and schematic. He came through with both, and kudos to him for such a clean hand-drawn schematic. Nice work [Alex]!

Source Code (Tarball)

Tue, 08 Jun 2010 21:17:00 -0500 Mike Szczys en-US text/html
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Your Health News and commentary about personal health, medicine, healthcare, drugs, diet, recipes, and nutrition. Download the Your Health podcast and subscribe to our RSS feed.

Walking, biking or even riding a scooter to get from place to place ups your non-exercise activity thermogenesis, or NEAT. Small movements can make a positive difference to your overall health. Laura Gao for NPR hide caption

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A popular asthma inhaler is leaving pharmacy shelves. Here's what you need to know

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There's an effective morning-after pill for STIs but it's not clear it works in women

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Giving gifts boosts happiness, research shows. So why do we feel frazzled?

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What parents need to know before giving kids melatonin

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Infertile people, gay and trans couples yearn for progress on lab-made eggs and sperm

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FDA approves first gene-editing treatment for human illness

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A fibrous path 'twixt heart and brain may make you swoon

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'Periodical' filmmaker wants to talk about PMS, menopause and the tampon tax

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Feeling alone? 5 tips to create connection and combat loneliness

Major flooding has hit Kenya in November. The disasters are likely intensified by climate change, and are causing ongoing health issues across the region. World leaders are discussing the health impacts of climate change at the COP28 climate meeting in Dubai this month. AFP via Getty Images/LUIS TATO hide caption

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Health is on the agenda at UN climate negotiations. Here's why that's a big deal

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Fri, 29 Dec 2023 10:00:00 -0600 en text/html
Cancer patients face frightening delays in treatment approvals

Marine Corps veteran Ron Winters clearly recalls his doctor's sobering assessment of his bladder cancer diagnosis in August 2022.

"This is bad," the 66-year-old Durant, Oklahoma, resident remembered his urologist saying. Winters braced for the fight of his life.

Little did he anticipate, however, that he wouldn't be waging war only against cancer. He also was up against the Department of Veterans Affairs, which Winters blames for dragging its feet and setting up obstacles that have delayed his treatments.

Winters didn't undergo cancer treatment at a VA facility. Instead, he sought care from a specialist through the Veterans Health Administration's Community Care Program, established in 2018 to enhance veterans' choices and reduce their wait times. But he said the prior authorization process was a prolonged nightmare.

"For them to take weeks — up to months — to provide an authorization is ridiculous," Winters said. "It doesn't matter if it's cancer or not."

Ron and Teresa Winters
Ron and Teresa Winters at their home in Durant, Oklahoma. Winters blames the Department of Veterans Affairs for setting up roadblocks that have delayed treatment for his bladder cancer.  Desiree Rios for KFF Health News

After his initial diagnosis, Winters said, he waited four weeks for the VA to approve the procedure that allowed his urologic oncologist at the University of Texas Southwestern Medical Center in Dallas to remove some of the cancer. Then, when he finished chemotherapy in March, he was forced to wait another month while the VA considered approving surgery to remove his bladder. Even routine imaging scans that Winters needs every 90 days to track progress require preapproval.

In a written response, VA press secretary Terrence Hayes acknowledged that a "delay in care is never acceptable." After KFF Health News inquired about Winters' case, the VA began working with him to get his ongoing care authorized.

"We will also urgently review this matter and take steps to ensure that it does not happen again," Hayes told KFF Health News.

Prior authorization isn't unique to the VA. Most private and federal health insurance programs require patients to secure preapprovals for certain treatments, tests, or prescription medications. The process is intended to reduce spending and avoid unnecessary, ineffective, or duplicative care, although the degree to which companies and agencies set these rules varies.

Insurers argue prior authorization makes the U.S. health care system more efficient by cutting waste — theoretically a win for patients who may be harmed by excessive or futile treatment. But critics say prior authorization has become a tool that insurers use to restrict or delay expensive care. It's an especially alarming issue for people diagnosed with cancer, for whom prompt treatment can mean the difference between life and death.

"I'm interested in value and affordability," said Fumiko Chino, a member of the Affordability Working Group for the Memorial Sloan Kettering Cancer Center. But the way prior authorization is used now allows insurers to implement "denial by delay," she said.

Cancer is one of the most expensive categories of disease to treat in the U.S., according to the Centers for Disease Control and Prevention. And, in 2019, patients spent more than $16 billion out-of-pocket on their cancer treatment, a report by the National Cancer Institute found.

To make matters worse, many cancer patients have had oncology care delayed because of prior authorization hurdles, with some facing delays of more than two weeks, according to research Chino and colleagues published in JAMA in October. Another recent study found that major insurers issued "unnecessary" initial denials in response to imaging requests, most often in endocrine and gastrointestinal cancer cases.

The federal government is weighing new rules designed to improve prior authorization for millions of people covered by Medicare, Medicaid, and federal marketplace plans. The reforms, if implemented, would shorten the period insurers are permitted to consider prior authorization requests and would also require companies to provide more information when they issue a denial.

In the meantime, patients — many of whom are facing the worst diagnosis of their lives — must navigate a system marked by roadblocks, red tape, and appeals.

"This is cruel and unusual," said Chino, a radiation oncologist. A two-week delay could be deadly, and that it continues to happen is "unconscionable," she said.

Chino's research has also shown that prior authorization is directly related to increased anxiety among cancer patients, eroding their trust in the health care system and wasting both the provider's and the patient's time.

Leslie Fisk, 62, of New Smyrna Beach, Florida, was diagnosed in 2021 with lung and brain cancer. After seven rounds of chemotherapy last year, her insurance company denied radiation treatment recommended by her doctors, deeming it medically unnecessary.

"I remember losing my mind. I need this radiation for my lungs," Fisk said. After fighting Florida Health Care Plans' denial "tooth and nail," Fisk said, the insurance company relented. The insurer did not respond to requests for comment.

Fisk called the whole process "horribly traumatic."

"You have to navigate the most complicated system on the planet," she said. "If you're just sitting there waiting for them to take care of you, they won't."

A new KFF report found that patients who are covered by Medicaid appear to be particularly impacted by prior authorization, regardless of their health concerns. About 1 in 5 adults on Medicaid reported that their insurer had denied or delayed prior approval for a treatment, service, visit, or drug — double the rate of adults with Medicare.

"Consumers with prior authorization problems tend to face other insurance problems," such as trouble finding an in-network provider or reaching the limit on covered services, the report noted. They are also "far more likely to experience serious health and financial consequences compared to people whose problems did not involve prior authorization."

In some cases, patients are pushing back.

In November, USA Today reported that Cigna admitted to making an error when it denied coverage to a 47-year-old Tennessee woman as she prepared to undergo a double-lung transplant to treat lung cancer. In Michigan, a former health insurance executive told ProPublica that the company had "crossed the line" in denying treatment for a man with lymphoma. And Blue Cross and Blue Shield of Louisiana "met its match" when the company denied a Texas trial lawyer's cancer treatment, ProPublica reported in November.

Countless others have turned to social media to shame their health insurance companies into approving prior authorization requests. Legislation has been introduced in at least 30 states — from California to North Carolina — to address the problem.

Back in Oklahoma, Ron Winters is still fighting. According to his wife, Teresa, the surgeon said if Ron could have undergone his operation sooner, they might have avoided removing his bladder.

In many ways, his story echoes the national VA scandal from nearly a decade ago, in which veterans across the country were languishing — some even dying — as they waited for care.

In 2014, for example, CNN reported on veteran Thomas Breen, who was kept waiting for months to be seen by a doctor at the VA in Phoenix. He died of stage 4 bladder cancer before the appointment was scheduled.

Winters' cancer has spread to his lungs. His diagnosis has advanced to stage 4.

"Really, nothing has changed," Teresa Winters said. "The VA's processes are still broken."

Do you have an experience with prior authorization you'd like to share? Click here to tell your story.

KFF Health News, formerly known as Kaiser Health News, is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Thu, 21 Dec 2023 20:00:00 -0600 en-US text/html Do You Know If Your Medicare Advantage Plan Requires Prior Authorization?

My 90-year-old uncle, a retired county employee, has had a Medicare Advantage preferred provider organization (PPO) plan for the last eight years. He sees his primary physician once or twice a year. However, now he has been experiencing dizzy spells and falls. His physician ordered a slew of medical tests. I asked my uncle, “Does your plan require prior authorization for these tests?” His reply was a shoulder shrug.

Because my uncle has no idea what prior authorization is, let alone whether or not his plan has those rules, I asked about any medical procedures he might have had recently. Four years ago, he had several medical tests without any issues. But that was before authorization was the big deal it is today. (In 2018, 61% of Medicare Advantage enrollees were in plans requiring authorization for procedures and lab tests. That increased to over 90% in 2021.)

It became clear that my uncle needed a crash course on prior authorization.

What is prior authorization?

Prior authorization, sometimes called preauthorization or prior approval, is a health insurer or plan’s decision that a healthcare service, treatment, prescription drug or durable medical equipment is medically necessary. Today, 99% of Medicare Advantage members are in plans that require prior approval for services including inpatient admissions, skilled nursing facility stays, mental health services, home health care, chiropractic services, outpatient surgery and services, ambulance transport, medical equipment, diagnostic tests, and laboratory and radiology services. (Plans cannot require authorization in emergency situations.)

For my uncle’s medical tests, the plan will either approve or deny the request. If the test is not authorized, the Medicare Advantage plan may not pay. In a plan’s Evidence of Coverage (EOC), the legal contract between the plan and you, there is language something like, “If prior authorization is required and not obtained, no benefits will be payable under the plan.” Translation: Pay attention to the fine print. If you don’t, you could be responsible for full payment.

How do you identify the requirements?

Prior to the fall Open Enrollment Period, Medicare Advantage plans will send a copy of the EOC or a link to it on the plan’s website. One of the easiest ways to locate whether or not these rules apply to your plan is to search the document for “prior authorization.” With his daughter’s help, my uncle accessed his EOC and found that the procedures he needs “may require” authorization. They are going to contact the physician and a plan representative for details, so he doesn’t end up on the hook.

What should you do about prior authorization?

A friend has lived with these requirements for several years. After determining that prior authorization applies in a specific situation, he follows a process that he shared with me.

  • Find a copy of your insurance company’s form or process. Check the website or call a plan representative. Your physician may need it and you’ll know exactly what information must be included.
  • Confirm that whoever in your physician’s office is in charge of this process knows that you need an authorization and the date due.
  • Double check that documentation is submitted, and that approval is received before the service. You may want to confirm your costs.
  • Remember, if you move forward without authorization, you might have to pay the full cost.

From a Medicare Advantage plan’s perspective, prior authorization can promote safe, timely, evidence-based, affordable, and efficient care. However, the American Medical Association believes that prior authorization “is overused, costly, inefficient, opaque and responsible for patient care delays” and is implementing measures to reform the process. Until then, for my uncle and all those with Medicare Advantage plans caught in the middle, it’s simply a fact of life. Knowing what to do will help you get the medical care you need.

Check out my website or some of my other work here
Wed, 01 Jun 2022 07:33:00 -0500 Diane Omdahl en text/html
Mental Health No result found, try new keyword!Hilarie Burton Says She Was 'Ashamed' to Hire a Baby Nurse to Help amid Postpartum Depression: 'Humiliating' Amy Robach Recalls Racing to T.J. Holmes' Side After She Feared He Had Harmed Himself ... Wed, 06 Jun 2018 12:20:00 -0500 en text/html Is there an ISA boost on the way?

The chancellor is reportedly planning a radical shake-up of ISAs to encourage people to take advantage of the tax-free products, and boost investment in UK companies.

According to a report in the Financial Times, Jeremy Hunt is considering introducing an additional tax-free allowance for investing in UK companies. This means that on top of the £20,000 annual ISA limit, there could be an extra allowance for holding British shares.

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