Prior Authorization News

The Workgroup for Electronic Data Interchange has launched its fall 2026 survey to assess industry readiness for the Centers for Medicare & Medicaid Services’ interoperability and prior authorization final rule.

AHA, CMS webinar explores how hospital and health system leaders can prepare for Medicare Advantage’s new electronic prior authorization mandate, which goes into effect Jan. 1, 2027.

An AHA blog published July 28 highlights new electronic prior authorization requirements that begin Jan. 1, 2027, as a result of the Centers for Medicare & Medicaid Services’ 2024 Interoperability and Prior Authorization final rule.

As major provisions of the 2024 Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule take effect next year, hospitals and health systems should begin preparing for changes to prior authorization workflows, payer interactions and information exchange.

Unacceptably, millions of Americans are struggling with healthcare costs. Many have chosen to skip prescriptions or other needed care because of concerns about costs; 4 in 10 Americans have medical debt.

The AHA provided comments June 15 to the Centers for Medicare & Medicaid Services on its proposed rule establishing electronic standards for drug prior authorizations.

The Medicaid and CHIP Payment and Access Commission June 15 released its June 2026 report to Congress.

The Centers for Medicare & Medicaid Services May 13 announced 29 health care organizations have pledged early participation in its electronic prior authorization initiative.

A majority of physicians say the prior authorization process continues to negatively impact patient outcomes and employee productivity, according to a survey released May 13 by the American Medical Association.

The Medicaid and CHIP Payment and Access Commission approved recommendations it will issue to Congress in its June report on oversight and increased transparency of artificial intelligence usage for prior authorization.

The Centers for Medicare & Medicaid Services May 5 announced a new electronic prior authorization initiative as part of its Health Technology Ecosystem.

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The Centers for Medicare & Medicaid Services April 10 released a

In a letter to the editor published March 3 by KFF Health News, Jim Prister, president and CEO of RML Specialty Hospital and chair of the AHA Post-Acute Steering Committee, urged Congress to address chronic underpayments and insurance barriers that are harming patient care and access to long-term care hospitals.

A KFF survey published today found that peopl

A Health Affairs study published Nov. 3 examined an increase in states banning prior authorizations in private insurance plans for opioid use disorder medications.

The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address multiple concerns.

The AHA Sept. 29 sent recommendations to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure insurance plans adhere to the agencies’ health insurer pledge to reform prior authorization processes.

The Centers for Medicare & Medicaid Services Innovation Center Aug. 12 released an FAQ on the Wasteful and Inappropriate Service Reduction Model, a six-year technology-enabled prior authorization program pilot.

The Centers for Medicare & Medicaid Services June 27 announced the rollout of a 6-year technology-enabled prior authorization program pilot.