Becker's Healthcare January 2, 2024
A new CMS rule aiming to streamline Medicare Advantage and Part D prior authorizations took effect Jan. 1.
CMS issued the final rule in April. It requires that 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, according to a CMS fact sheet.
It also requires coordinated care plans to provide a minimum 90-day transition period when a beneficiary undergoing treatment switches to a new MA plan. During this period, the new...
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