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December 21, 2022

CMS Publishes Proposed Rule That Will Expand Access to Health Information and Improve the Prior Authorization Process

CMS published a proposed rule on December 13 to improve patient and provider access to health information and simplify prior authorization processes. The proposed rule applies to Medicare Advantage, Medicaid, and federally-facilitated Marketplace health plans.  It requires them to implement an electronic prior authorization process, shorten response times for prior authorization requests, and establish policies to improve transparency. In a statement by the American Hospital Association, industry stakeholders have commended these efforts as important steps to streamlining care and removing barriers, delays, and unnecessary costs in providing care. CMS estimates that the policies introduced in the proposed rule will save physician practices and hospitals over $15 billion over a 10-year period. Key considerations of the proposed rule are its application to popular Medicare Advantage plans, HIPAA compliance, and data exchange provisions.  The deadline to submit comments on the rule is March 13, 2023. 

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