Healthcare DIVE December 19, 2022
Proposed changes target prior authorization holdups and misleading advertising while aiming to expand access to behavioral health care and affordable prescriptions.
A new CMS rule designed to strengthen Medicare Advantage is generating positive feedback for its proposals to streamline the prior authorization process, expand access to behavioral health care, make prescription drugs more affordable and stop misleading advertising.
Among other changes, the rule would revise prior authorization requirements to reduce disruption for enrollees, so that an approval would remain valid for a full course of treatment. MA plans would be required to review utilization management policies annually, with coverage determinations evaluated by professionals with relevant expertise.
The proposed rule released last week takes “important steps to hold Medicare Advantage plans...
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