CMS Eyes Mandating Electronic Prior Authorization Systems By 2026
The proposed rule calls for Medicare Advantage, Medicaid, and some other health insurance exchanges to update prior authorization processes. Among the potential mandates are for payers to respond to “urgent” requests within 72 hours, justify denials, and report decisions.
Modern Healthcare:
Health Insurance Prior Authorization Rules Proposed By CMS
The regulation would require Medicare Advantage, Medicaid and health insurance exchange carriers to ease their prior authorization processes and respond to “urgent” requests within 72 hours and standard requests within seven days. This would halve the amount of time Medicare Advantage plans currently have to respond to clinicians’ prior authorization requests, according to CMS. (Tepper, 12/6)
Bloomberg Law:
Health Insurers Look To Move Ex-Medicaid Customers To Obamacare
Insurers hope to soften the financial hit from the expected end of the Covid-19 health emergency next year by steering some of their departing Medicaid enrollees into their individual marketplace plans. Doing so will give carriers like UnitedHealthcare, Aetna CVS Health, and Ambetter Health, Centene Corp.‘s marketplace provider, an opportunity to retain billions of dollars in revenue that would otherwise disappear. That’s because millions of their Medicaid managed care enrollees will no longer qualify for Medicaid once the public health emergency is lifted and the federal requirement for continuous Medicaid enrollment ends. (Pugh, 11/7)
In Medicaid news from the states—
North Carolina Health News:
Study: Medicaid Transition Still Facing Problems
When North Carolina swapped its Medicaid system from a program run by the state to a program run and managed by five insurance companies, researchers at the Urban Institute — a D.C.-based think tank — took note. Among other policies, the organization’s researchers took a look at how transitions to Medicaid managed care impact patients nationwide. (Donnelly-DeRoven, 12/7)
St. Louis Post-Dispatch:
Bipartisan Effort Underway To Extend Health Coverage For New Moms In Missouri
Missouri lawmakers are set to consider plans to extend Medicaid coverage for new moms and their babies after a similar idea fell short earlier this year. Five bills have been introduced in the Missouri House that would extend insurance coverage for low-income mothers from a current 60 days after giving birth to 12 months. Two other versions have been introduced in the Senate. (Erickson, 12/6)
Stateline:
More States Offer Health Coverage To Immigrant Children
Come January, Connecticut and New Jersey will join the nine states plus Washington, D.C., that already allow children without permanent legal status to enroll in either Medicaid, the public health plan for residents with lower incomes, or in its sister program, the Children’s Health Insurance Program, known as CHIP. (Ollove, 12/6)
KHN:
Watch: Big Medicaid Changes In California Leave Millions Of Patients Behind
KHN senior correspondent Angela Hart appeared on Spectrum News 1’s “Los Angeles Times Today” on Nov. 29 to discuss her reporting on California’s pricey and ambitious experiment to transform its Medicaid program, called Medi-Cal. The initiative, known as CalAIM, will provide some of Medi-Cal’s sickest and costliest patients with social services such as home-delivered healthy meals, help with housing move-in costs, and home repairs to make living environments safer for people with asthma. (12/7)
