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CHA Issues Summary of Proposed Rule on Prior Authorization Processes

For CEOs, CFOs, finance & reimbursement staff, government relations staff

CHA has issued a detailed summary, prepared by Health Policy Alternatives, of the recently issued proposed rule by the Centers for Medicare & Medicaid Services (CMS) — in coordination with the Office of the National Coordinator for Health Information Technology — to improve the electronic exchange of health care information, including to streamline and reduce the burden associated with health plan prior authorization processes through Application Programming Interfaces. 

The summary details the proposed requirements that would be implemented by state Medicaid fee-for-service (FFS) programs, Medicaid managed care plans, state Children’s Health Insurance Program (CHIP) FFS programs, CHIP managed care entities, and qualified health plan issuers on the federally facilitated exchange (or Health Insurance Marketplace). CMS does not propose to include FFS Medicare or issuers offering health plans through the Medicare Advantage program.  

Comments on the proposed rule are due to CMS by 2 p.m. (PT) on Jan. 4, 2021.