The Centers for Medicare & Medicaid Services (CMS) released a final rule on Medicare Parts C and D earlier this week that addresses a number of changes to the programs, including changes to the authorization process under Medicare Advantage (MA).
NCMS staff are still reviewing the rule, but it appears that many of the provisions NCMS, the AMA, and other health care stakeholders advocated for in correspondence sent to CMS in February, including improved clinical validity of coverage criteria, increased transparency regarding prior authorization processes, have been finalized. These changes will take effect on January 1, 2024.
To read the rule in full click here.
To read the February letter that NCMS joined click here.