Topic
Prior Authorization
53 published works
Med Law Blog
New CMS Model Targets Inefficient Medicare Spending Through AI and Clinical Oversight
The Centers for Medicare & Medicaid Services (CMS) has launched the WISeR Model (Wasteful and Inappropriate Service Reduction) to modernize and streamline Medicare's prior authorization process. By partnering with tech…
Pharmacy & Healthcare Legal Blog
Improperly prepared PAs still cause trouble
I remember times when pharmacies were able to prepare and submit prior authorizations (PAs) on behalf of the prescribers. Then, gears shifted and pharmacies were allowed to fill out PAs…
Pharmacy & Healthcare Legal Blog
OptumRx eases prior authorization requirements on about 80 drugs
OptumRx has recently announced that it is easing its prior authorization (PA) requirements on about 80 drugs for renewed prescriptions. The program is planned to start on May 1, 2025…
Healthcare Law Blog
California Limits Health Plan Use of AI in Utilization Management
By Carolyn Metnick, Lynsey Mitchel, Michael Sutton
California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to…
Triage Health Law
CMS Finalizes a New Rule to Require Extensive API Implementation and Quicker Turnaround for Prior Authorization Decisions: What Payers Should Know
On January 17, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule regarding interoperability and prior authorization (the “Rule”). CMS-0057-F. The Rule’s goals, according to CMS,…
Healthcare Law Blog
CMS Finalizes its Proposal to Advance Interoperability and Improve Prior Authorization Processes
By Gianfranco Spinelli, Krysten Thomas
On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and…
Take Stock: Federal Policy Watch
Washington Healthcare Update | January 22, 2024
By Stephanie A. Kennan, Gina Sherick, Gabriel Wiedenhoever
This Week in Washington: Congress passes continuing resolution; CMS releases final rule concerning prior authorization. Congress House The House is in district work week. Congress Passes Continuing Resolution On Jan.…
PrawfsBlawg
Dr. Glaucomflecken on Prior Authorizations
Main Tuesday, May 23, 2023Dr. Glaucomflecken on Prior Authorizations Posted by Steve Lubet on May 23, 2023 at 06:17 AM | Permalink CommentsThe comments to this entry are closed.
Health Law
CMS Issues a New “Advancing Interoperability and Improving Prior Authorization Processes” Proposed Rule
By Tara Singh
On December 6, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Proposed Rule that would (i) further enhance health data exchange by establishing data exchange standards for certain payers,…
Healthcare Law Blog
CMS Includes MAOs in Data Exchange and Prior Authorization Requirements
The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider…