Becker's Healthcare January 18, 2024
A group of lawmakers that has been pushing for Medicare Advantage prior authorization reforms applauded the rule CMS finalized Jan. 17 but said Congress must now “cement these gains into law.”
Beginning primarily in 2026, certain payers will be required to include a specific reason when denying requests, publicly report certain prior authorization metrics and send decisions within 72 hours for urgent requests and seven calendar days for standard requests.
The rule also requires affected payers to implement a Health Level 7 Fast Healthcare Interoperability Resources standard application programming interface to support electronic prior authorization.
The lawmakers said that “while these regulations could have gone further, they will help bring the antiquated prior authorization system into the...
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