January 18, 2024- The Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule on January 7, 2024. The rule sets requirements for government health organizations to improve the electronic exchange of health information and prior authorization processes for medical items and services.
The American Hospital Association (AHA), in response to the announcement, stated that it “commends CMS for removing barriers to removing barriers to patient care by streamlining the prior authorization process.”
Prior authorization can help ensure that medical care is necessary and appropriate, but it can sometimes be an obstacle to patient care, requiring providers to navigate complex payer requirements and face long waits.
This final rule establishes requirements for certain payers to streamline the prior authorization process and complements the Medicare Advantage requirements finalized, which add continuity of care requirements and reduce disruptions for beneficiaries.
“With this final rule, CMS addresses a practice that too often has been used in a manner that leads to dangerous delays in patient treatment and clinician burnout in the health care system. AHA is grateful to CMS for its efforts to improve patient access to care and help clinicians focus on patient care,” according to AHA President and CEO Rick Pollack.