By Consumers for Quality Care, on February 7, 2024
A new rule finalized by the Centers for Medicare & Medicaid Services (CMS) will soon reduce long and laborious decision times typically associated with the prior authorization process, according to Healthcare Dive.
Specifically, the new rule, set to take effect in 2026, will require insurers to respond within 72 hours for urgent cases and within seven days for standard requests.
By requiring health insurers to make quicker decisions on prior authorization requests, CMS’ new rule seeks to address a common frustration among patients and health care providers, potentially leading to faster access to necessary medical services.
The new rule will also require insurers to provide specific reasons for prior authorization denials, which should help providers by improving their chances of successfully appealing denials, ensuring that patients receive necessary care without undue delays.
The new rule is expected to generate $15 billion in savings over the next decade, as well as expedite critical decisions consumers rely on for their health care.
While the rule does not eliminate prior authorization, it seeks to strike a balance between cost control and patient access to care.
CQC applauds this action by CMS and urges lawmakers and providers to eliminate needless, burdensome processes that prevent consumers from receiving the medical care they need.