Back to archive page
CHA News

CMS Issues Proposed Rule on Prior Authorization Requests

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

The Centers for Medicare & Medicaid Services (CMS), in coordination with the Office of the National Coordinator for Health Information Technology (ONC), has issued a proposed rule to build on efforts to improve the electronic exchange of health care information, including to streamline and reduce the burden associated with health plan prior authorization processes.  

The proposed requirements would apply to 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). Some requirements only apply to a subset of these coverage programs.  

CMS does not propose to include FFS Medicare or issuers offering health plans through the Medicare Advantage program. 

Comments are due to CMS by 2 p.m. (PT) on Jan. 4, 2021. CHA is currently reviewing the proposed rule and will provide members with additional information via CHA News.