December 8, 2022
CMS issues "Advancing Interoperability and Improving Prior Authorization Processes" proposed rule
On December 6, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule, "Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, etc." The rule, which formally withdraws the December 2020 CMS interoperability and prior authorization rule and builds on CMS' May 2020 interoperability final rule, includes new requirements for insurers participating in Medicare Advantage (MA), Medicaid, the Children's Health Insurance Program, and the Affordable Care Act exchanges, as well as performance measures for providers to improve electronic health care data exchange between providers and insurers and streamline the prior authorization process for items and services. If finalized, CMS intends to implement many of the provisions for Medicare fee-for-service (FFS) and seeks comment on ways to apply these requirements to Medicare FFS. The proposed rule also includes five requests for information on how to build on these proposals and better incorporate data on behavioral health, maternal health, and social factors.
Additional information is also available in the attached Tax Alert.
CMS proposed rule