The Centers for Medicare & Medicaid Services (CMS) has proposed changes that could reshape how healthcare providers use electronic prior authorization starting in 2027. The alert examines the agency’s proposed calendar year (CY) 2027 Physician Fee Schedule rule, which would modify incentives for such use under the Merit-based Incentive Payment System (MIPS) and the Ambulatory Specialty Model. The alert highlights proposed changes that would make the electronic prior authorization measure optional in 2027 and mandatory beginning in 2028, with a requirement to use Fast Healthcare Interoperability Resources (FHIR)-enabled, Office of the National Coordinator for Health Information Technology (ONC)-certified health IT modules, along with a new drug-specific prior authorization measure beginning in 2028.
It also discusses parallel proposals for Accountable Care Organizations (ACOs), including new certified electronic health record technology reporting options and a request for information on applying electronic prior authorization measures to Medicare Shared Savings Program ACOs. Comments on the proposed rule are due September 14, 2026.
Read the full alert.