CMS Issues Final Rule on Medicare Advantage Prior Authorization Requirements
May 8, 2023
The US Centers for Medicare and Medicaid Services (CMS) has issued its final rule on prior authorization requirements for Medicare Advantage (MA) plans. The rule changes ensure that prior authorization approvals last as long as medically necessary, that plans must only use prior authorization policies to check diagnoses, and that plans must give beneficiaries a 90-day transition period when changing plans.
According to Kelli Howe, “The industry comments documented by CMS throughout the 2024 Final Rule evidence mixed support for the now-finalized provisions. Supporters applauded CMS for acting upon the OIG’s recommendations and taking steps to reduce what they see as barriers to medically necessary care. Critics, however, expressed concerns with the implementation logistics and timing of the changes, with many suggesting CMS delay the effective date of such changes to align with future rulemaking related to interoperability.13 While it did modify some of its proposed provisions in response to industry comments on the previously proposed rule, CMS, reiterating feedback received from the OIG and other industry stakeholders about the need for clarified guidance and transparency, is moving forward with the finalized provisions to take effect January 1, 2024.”
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(Source: Mondaq, May 8th, 2023)
