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CMS Finalizes its Proposal to Advance Interoperability and Improve Prior Authorization Processes

Healthcare Law Blog

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

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CMS Imposes New Requirements on Payers to Improve Prior Authorization Process and Payer, Patient and Provider Communications

Hall Render

The improved information requirements apply to the following payers, including: Medicare Advantage plans; Medicaid and Children’s Health Insurance Program (“CHIP”) managed care plans; State Medicaid and CHIP fee-for-service payers; and Qualified Health Plans only in the Federally Facilitated Exchanges.

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The $4 Trillion Health Economy of 2020

Health Populi

Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. trillion in 2026 when healthcare spending will be $1 in every $5 in the American economy (approaching 20%).

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CMS Issues a New “Advancing Interoperability and Improving Prior Authorization Processes” Proposed Rule

C&M Health Law

Most of the Proposed Rule’s provisions will be effective on January 1, 2026. The below summary does not focus on the Medicaid and Children’s Health Insurance Program (CHIP) Fee for Service (FFS) proposals. The deadline to submit comments is March 13, 2023. Our initial takeaways are summarized below.

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CMS Includes MAOs in Data Exchange and Prior Authorization Requirements

Healthcare Law Blog

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

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As Medical Cost Trend Remains Flat, Patients Face Growing Health Consumer Financial Stress

Health Populi

. “Employer health spending has grown from 6 percent of total wages in 1988 to more than 12 percent in 2018,” driven by healthcare prices growing faster than the general economy, and the adoption of new technologies, procedures, and increasingly expensive new prescription drugs, PwC observes. economy by 2026.

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Countercyclical Aid Is Not Enough to Fix the Broken US Approach to Public Health Financing

Bill of Health

While this program represented the largest intergovernmental transfer of multipurpose funds in over 40 years, one-time funds discourage elected officials from making investments that will need to be sustained beyond the program’s 2026 expiration date. This precludes rebuilding the decimated public health workforce.