Managed Care | December 07, 2022

CMS Issues Proposed Rule on Advancing Interoperability & Prior Authorization Processes

CMS will publish a 403-page proposed rule in the Federal Register on Dec. 13 looking at advancing interoperability and improving prior authorization processes for Medicare Advantage organizations(MAOs), Medicaid managed care plans, state Medicaid agencies, federal exchange health plans and other federal programs. Congressional leaders have been awaiting this rule in the hopes that it will make significant progress on the MAO prior authorizations issues noted in an April 2022 Office of Inspector General Report. The extent of this rule will influence whether Congress moves ahead with its Improving Seniors’ Timely Access to Care bill, which has been considered for year-end action but has been thwarted due to a $16B implementation price tag.  LeadingAge will be reviewing and commenting, as appropriate, on the proposed rule though initial indications are it focuses heavily on what the payers must do. Comments are due March 13, 2023.