Prior Authorization Final Rule Released | SCAI

CMS released the Interoperability and Prior Authorization Final Rule on January 17, 2024. This long-awaited rule finalizes CMS policies that will help to curtail burdensome prior authorization policies in Medicare Advantage and Medicaid programs. The rule includes requirements that payers implement an electronic prior authorization system, reduce decision timelines to 72 hours for urgent requests and seven days for routine requests, and provide a specific denial reason when prior authorization requests are denied. SCAI applauds CMS’ decision to implement policies that will reduce burden and ensure seniors have timely access to care.

In addition, Congress is considering codifying this rule and expanding several related matters. 

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