Lexology May 31, 2023
CMS Finalizes New Rules for Medicare Advantage Marketing and Prior Authorizations
Centers for Medicare & Medicaid Services (“CMS”) recently finalized new rules (88 FR 22120) seeking to streamline Medicare Advantage (“MA”) and Medicare Part D prior authorizations and further penalize misleading marketing practices. The final rule takes effect on June 5, 2023.
Regarding prior authorizations, coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary. Coordinated care plans must also provide a minimum 90-day transition period when a beneficiary undergoing treatment switches to a new MA plan, during which the new plan cannot require prior authorization for the active course...
Today's Sponsors
Today's Sponsor