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CMS proposes new prior authorization requirements for payers, including MA plans

CMS Proposes Major Changes to Prior Authorization

COVID-19 Vaccine Provider Access and Vaccination Coverage Among Children Aged 5–11 Years — United States, November 2021–January 2022

This report describes COVID-19 vaccine provider access and vaccination coverage among U.S. children aged 5–11 years.

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Prescription Monitoring Program (PMP)

CMS announces proposed rule to improve electronic data exchange and streamline prior authorization | Bricker & Eckler LLP

To embed, copy and paste the code into your website or blog: On December 11, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule designed to improve electronic health care data exchange and streamline the prior authorization process. The CMS fact sheet accompanying the proposed rule stated that its goal is “reducing overall payer and provider burden and improving patient access to health information.” The proposed rule includes five sets of proposals and five requests for information. The proposals include the following: Patient Access Application Programming Interface (API) – This proposal builds on the Interoperability and Patient Access final rule, which required certain payers to implement a Fast Healthcare Interoperability Resources-based Patient Access API. CMS would now require these payers to include information about patients’ pending and active prior authorization decisions in the API. These payers would also be required to maintain

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