New Prior Authorization Proposal Is Likely Here to Stay

December 18

Building on previously finalized regulations aimed at advancing data interoperability in health care, CMS on Dec. 10 proposed a new rule that would require certain health plans to make their prior authorization processes more efficient and share even more data with providers and patients.

Although the proposal is arriving in the waning days of the Trump administration, it will likely survive the transfer of executive power, one health policy expert tells AIS Health. As for the affected health plans, complying with the new directives probably won’t take a herculean effort considering they’re already doing so much to modernize their data systems to align with the new interoperability mandates, another expert says. However, preparing to comply with all the new requirements is going to be challenging.

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Health Plan Weekly

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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