January 19, 2024
The Centers for Medicare & Medicaid Services (CMS) has finalized the CMS Interoperability and Prior Authorization final rule (CMS-0057-F). The rule sets requirements for Medicare Advantage organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans offered on the Federally-Facilitated Exchanges (collectively “impacted payers”), to improve the electronic exchange of health information and prior authorization processes for medical items and services. These policies will improve prior authorization processes and reduce the burden on patients, providers, and payers, resulting in approximately $15 billion of estimated savings over 10 years.
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