The Centers for Medicare & Medicaid Services (CMS) has finalized policies on marketing oversight, prescription drugs, and prior authorization processes in its 2024 Medicare Advantage (MA) and Part D Final Rule. The finalized standards are meant to streamline the prior authorization process and ensure beneficiaries’ consistent access to medically necessary care. The new criteria, which align Medicare Advantage laws with those under regular Medicare and lessen the administrative burden, have received praise from healthcare providers. The prior authorization policies will take effect on January 1, 2024.
The Centers for Medicare & Medicaid Services (CMS) recently released its 2024 Medicare Advantage (MA) and Part D Final Rule, which emphasizes prior authorization procedures, prescription medications, and marketing supervision. The prior authorization process has become a significant regulatory burden for medical practices in recent years. The final rule tries to modernize it.
According to data from the American Medical Association (AMA), physicians complete an average of 41 prior authorizations each week and spend an average of two business days on the process. Additionally, 93 percent of physicians reported that patients face delays in accessing necessary care while waiting for health plans to authorize treatment or services.
The finalized requirements in the MA and Part D final rules aim to streamline the prior authorization process and ensure that beneficiaries have consistent access to medically necessary care. The final rule directs coordinated care plans to provide a minimum 90-day transition period when a beneficiary undergoing treatment switches to a new Medicare Advantage plan, during which the new plan cannot require prior authorization for the active treatment.
Provider organizations have commended CMS for the requirements in the final rule, which include provisions that ensure greater continuity of care, improve the clinical validity of coverage criteria, increase the transparency of health plans’ prior authorization processes, and reduce care disruptions due to prior authorization requirements.
Healthcare professionals believe that the approved requirements are a significant victory for providers. The policies will help reduce the administrative burden and align Medicare Advantage regulations with those under traditional Medicare. Although some provider organizations have expressed wariness about CMS holding insurance companies accountable for following the new requirements, healthcare experts are confident that the agency will follow suit.
The prior authorization policies in the final rule do not take effect until January 1, 2024. However, some health plans have already limited their use of the process in the aftermath of various studies on prior authorization, including a report from the HHS Office of Inspector General.
Overall, the finalized requirements in the MA and Part D final rules represent a step forward in reducing the regulatory burden of prior authorization for providers and ensuring that beneficiaries have consistent access to medically necessary care.