CMS finalizes long-awaited prior authorization rule for Medicare Advantage

McKnight's January 18, 2024
Josh Henreckson

A new rule on Medicare Advantage prior authorization finalized by the Centers for Medicare & Medicaid Services Wednesday suggests good news for providers and Medicare recipients.

The updated regulations are the latest in a string of recent signals that CMS is taking long-term care leaders’ concerns about MA plans seriously, stakeholders said.

Under the new rule, plans will have three days to send prior authorization decisions for expedited requests and seven days for standard requests. This will cut decision times by as much as half, according to a report on the rule from the US Department of Health and Human Services.

Any denials of coverage also will need to include the reasoning behind the denial, CMS wrote in a...

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