CMS Unveils Rule To Streamline Prior Authorization Decisions

On Dec. 10, CMS issued a proposed rule titled “Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information.” The proposal would place new requirements for improving the electronic exchange of health care data and streamline prior authorization processes on Medicaid and Children’s Health Insurance Program (CHIP) managed care plans, state Medicaid and CHIP fee-for-service programs and Qualified Health Plans. Most of the provisions in the rule would go into effect on Jan. 1, 2023.

Click here for the CMS press release and here for the agency’s fact sheet about the proposal.