The Centers for Medicare & Medicaid Services late today issued a proposed rule that seeks to streamline prior authorization processes implemented by health plans serving the Medicaid, Children’s Health Insurance Program and federal Health Insurance Marketplace.

These plans would be required to build and implement certain application programming interfaces that could allow providers to know in advance what documentation is needed for a prior authorization request, streamline the documentation process, and enable providers to send requests and receive responses electronically, including directly from the electronic medical record or other practice management system.

Notably, Medicare Advantage plans would excluded from the rule, but the agency indicates it is considering whether to include them in future rulemaking.

For more, see the CMS news release. Comments on the rule are due Jan. 4, 2021.

Related News Articles

Headline
The House July 3 voted 218-214 to pass the final version of the One Big Beautiful Bill Act (H.R. 1), which enacts many of President Trump’s legislative…
Headline
The Senate narrowly passed the One Big Beautiful Bill Act (H.R. 1) on July 1 by a 50-50 tally, with Vice President J.D. Vance casting the tie-breaking vote.…
Headline
The AHA June 29 sent a letter to senators urging them to amend the budget reconciliation bill before its final passage in the Senate. The Senate version of the…
Headline
The latest video in the AHA’s series “Medicaid: Real Lives, Real Care” features Melissa Fannon-Wisner, DNP, nurse educator and nurse practitioner at Valley…
Headline
In a Q&A, Becky Pletzer, a social worker and mother, explains how critical Medicaid has been to support her son with disabilities, and why cuts to the…
Blog
Public
A Q&A with Becky Pletzer, social worker and parent to a son with disabilities Q: Can you tell me about yourself and your family?A: I’m Dr. Becky…