Petauri PACT Executive Briefings - 3-Minute Market Insights
Welcome to the Petauri PACT Executive Briefing, where in 3-minutes we highlight healthcare’s critical market access issues, policies, challenges, or trends. This resource offers condensed, 3-minute episodes of market insights.
Our passion is on achieving the Quintuple Aim of enhancing patient experience, improving population health, reducing costs, improving the work life of health care providers and staff., and enhancing health equity in all aspects of care delivery.
I’m Dr. Warren Smedley, thank you for joining us.
Petauri PACT Executive Briefings - 3-Minute Market Insights
CMS Prior Authorization Final Rule
Today's topic is the CMS Prior Authorization Final Rule
On January 17th, 2024, CMS published the CMS Interoperability and Prior Authorization Final Rule, to improve the electronic exchange of health care data as well as to streamline prior authorization processes. This final rule also adds a new measure for merit-based incentive payment system or MIPS eligible clinicians.
Beginning in January 2026, health insurers participating in federal programs including Medicare advantage and Medicaid, must respond to expedited (that's "urgent") prior authorization requests within 72 hours and standard (or "non-urgent") requests within seven days. Insurers must also include their reasons for denying a prior authorization request and will be required to publicly release data on denial and approval rates for medical treatment.
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