Prior Authorizations, 340B, and a National Provider Directory

Lexology December 14, 2022
Riker Danzig LLP

CMS Proposes Streamlining The Prior Authorization Process

The Centers for Medicare & Medicaid Services (“CMS”) recently announced that it would issue a proposed rule seeking to streamline the prior authorization process, estimating that such changes will save hospitals and physician practices more than $15 billion over a 10-year period.

Changes under the proposed rule (CMS-0057-P) would generally apply to Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program (“CHIP”) agencies, Medicaid managed care plans, CHIP managed care entities, and qualified health plan insurers on the federally facilitated exchanges. Specific changes under the proposed rule include:

1. Requiring the implementation of a Health Level 7 Fast Healthcare Interoperability Resources standard application programming interface to support electronic prior authorization;
2. Requiring certain...

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