CMS Finalizes Medicare Advantage Prior Authorization Reforms
On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized its proposals to reform Medicare Advantage plan prior authorization policies to improve transparency. The new regulations are effective June 5, 2023, and applicable to coverage beginning January 1, 2024, unless otherwise noted. The changes are intended to ensure that Medicare Advantage enrollees have consistent access to medically- necessary care while also maintaining medical management tools. The final rule also streamlines prior authorization requirements, including adding continuity of …
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