New Medicare Prior Authorization Rule: Preliminary Analysis

On December 6, 2022, the Centers for Medicare and Medicaid Services (CMS) released its Advancing Interoperability and Improving Prior Authorization Process Proposed Rule.

The proposed rule extends to Medicare Advantage in addition to Medicaid and federally-facilitated Marketplace health plans, promoting alignment of prior authorization requests across coverage types.

If finalized, the proposed provisions would go into effect January 1, 2026. While not eliminating prior authorization, this proposed rule would mandate that payors develop and implement an automated process. Click here 🔒 to read IPSIS’ members-only preliminary analysis.