In the Press
April 12, 2023

CMS’s Proposed Rule Improves Prior Authorization Processes (New York Law Journal)

The Centers for Medicare & Medicaid Services’ (CMS) has recently demonstrated a focus on promoting patient care by removing unnecessary obstacles to prior authorization. Prior authorization is a payer-established process that requires healthcare providers, such as hospitals, clinics, or doctors, to obtain advance approval of products and services to be paid by insurers. The comment period closed for CMS’s proposed new rule regarding prior authorization of healthcare services and products (87 Fed. Reg. 76238) closed on March 13, 2023. Relatedly, on April 5, 2023, CMS approved a final rule streamlining prior authorization requirements for Medicare Advantage enrollees and requiring that a granted prior authorization approval remain valid for as long as medically necessary. The Medicare Advantage rules are intended to complement the proposals in CMS’ prior authorization rule, which Complex Litigation & Dispute Resolution counsel Katie Cheng and partner William Jackson address in the New York Law Journal.