CMS Publishes Proposal to Improve the Prior Authorization Process

The US Center for Medicare and Medicaid Services’ (CMS’s) Interoperability and Patient Access Final Rule ensures patient acccess to clinical data, adjucated claims, and other health information. The newly published Advancing Interoperabilty and Improving Prior Authorization Processes Proposed Rule would, if implemented, extend the prior rule with 5 key proposals targetting health data access and prior authorization.

According to Pat Oulette, “Impacted payors would need to make the information available to patients no later than one business day after the payor receives the PA request or following another type of status change for the PA. This portion of the Prior Authorization Proposed Rule is geared at helping patients better understand their respective payor’s PA processes and the effect on their care. The rule would also require impacted payors to report annual metrics to CMS about patient use of the Patient Access API.”

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(Source: Mintz, April 12^th, 2023)