Complete Story
01/17/2024
CMS Announces Final Rules Regulation Medicare Advantage Prior Authorization
OSMA continues to advocate for changes to the prior authorization at both the state and federal level.
We have joined the advocacy efforts of our national and other state partners to push CMS to address the overly burdensome prior authorization process used by Medicare Advantage plans and other products regulated by the federal government. We are pleased to report that earlier this week, CMS announced its final rule package that will address some of the challenges physicians face with the prior authorization system.
The CMS Interoperability and Prior Authorization Final Rule sets requirements for a variety of federally provided and regulated health insurers including:
- Medicare Advantage plans.
- Medicaid and CHIP fee-for-services.
- Managed care plans and qualified health plans on the federal exchange.
Specifically related to prior authorization the rules will tighten the time frame for PA decisions, require detailed information on denials, require disclosure and public reporting of plan metrics related to PA and place detailed requirements on receiving electronic submission of PAS. While legislative efforts are ongoing at the state and federal level to produce major reforms, this rule is certainly a good first step that will benefits physician practices and patients.