Medicare Advantage Plans’ Prior Auth Rules Would Be Made Public Under CMS Proposal

MedPage Today November 26, 2024
Joyce Frieden

— Rule would also make provider directories easier to compare

Medicare Advantage plans’ prior authorization rules and coverage criteria would become publicly available under a proposed rule issued Tuesday by the Centers for Medicare & Medicaid Services (CMS).

The Biden Harris administration has “worked over the last 3 years to reform the way that Medicare Advantage plans can use prior authorization to ensure that patients can access the care they need,” Meena Seshamani, MD, PhD, director of the Center for Medicare, said on a call with reporters. “Today, we are taking an additional step further to address the inappropriate use of prior authorization.”

“Data reported to CMS by MA [Medicare Advantage] plans indicates that, on average, MA plans overturn 80%...

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