New Prior Authorization Reforms May Not Be Problematic for Health Plans

In a rule proposed on Dec. 6, CMS seeks to impose new requirements on federally funded health plans surrounding their prior authorization processes and data interoperability. While that might normally induce private payers to push back, the health insurance sector’s main trade group has already endorsed the regulation, which CMS issued to replace a previously proposed rule that appears to have generated more industry pushback. Health care industry observers, meanwhile, tell AIS Health that the new requirements could be a win for consumers, providers, and payers alike.

“I think it’s good for the business,” says Katherine Hempstead, Ph.D., a senior policy adviser at the Robert Wood Johnson Foundation. “It’s good immediately for consumers and providers, and it’s good in the long run for plans. It’s going to be better for everyone.”

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