New CMS prior authorization rule takes effect

Eileen Cook January 3, 2024January 3, 2024 CMS, Medicare Advantage, Medicare Advantage Prior Authorization, Medicare Part D, Prior Authorization

(By Andrew Cass for Becker’s Hospital Review)

A new CMS rule aiming to streamline Medicare Advantage and Part D prior authorizations took effect Jan. 1.

CMS issued the final rule in April. It requires that coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary, according to a CMS fact sheet. Continue reading here…

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