Becker's Healthcare February 23, 2023
CMS is proposing to streamline and improve prior authorizations with new and added rules, according to a Feb. 21 Kaiser Family Foundation report.
Five notes:
1. The proposal includes new requirements for the prior authorization process and adding new timeframes for decision-making that apply for Medicare Advantage plans, Medicaid managed care plans, Medicaid fee-for-service plans, CHIP managed care and FFS arrangements and qualified health plans on the federally facilitated health insurance marketplace. The majority of the new rules wouldn’t go into effect until 2026.
2. Under the proposal, affected payers would have to use a specific API, give providers relevant information about prior authorization statuses and publicly report specific metrics yearly. Metrics would include the percent of prior authorizations...
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