Biden Admin Rule Forces Insurers To Not Dilly-Dally On Prior Authorization
A new rule now applies to health insurance companies that offer Medicare, Medicaid, Children's Health Insurance Program, and Obamacare plans. It forces insurers to explain specifically why they denied coverage, and to speed up the pre-approval process.
Stat:
Prior Authorization Will Have To Move Faster Under New Biden Rule
The Biden administration moved Wednesday to force insurance companies to give specific reasons for denying coverage, and to speed up the pre-approval process in general. The new rule applies to health insurance companies that offer Medicare, Medicaid, Children’s Health Insurance Program, and Obamacare plans. It concerns so-called prior authorization requests, and will require insurers to return urgent requests within 72 hours and non-urgent requests within seven days. (Trang, 1/17)
Roll Call:
Biden Administration Finalizes Prior Authorization Changes
Specifically, beginning in 2026, the rule would require that Medicare Advantage plans, Medicaid and Children’s Health Insurance Program managed care and fee-for-service plans respond to non-urgent requests no later than seven calendar days.
Those plans, as well as plans on the federally facilitated exchanges, would have 72 hours to respond to urgent requests. The rule allows for extensions in some circumstances. The timelines are the same ones proposed by the Biden administration in 2022. (Hellmann, 1/17)
Axios:
New Limits On Prior Authorization Hailed As Good First Step
New federal rules requiring health insurers to streamline requests to cover treatments are being hailed as a good first step toward addressing a problem that's increasingly aggravated patients and doctors. But it may not be Washington's last word on so-called prior authorization, as lawmakers look to jumpstart legislation that would further limit the practice. (Goldman, 1/18)
Also —
Axios:
How A Supreme Court Case Over Federal Power Could Affect U.S. Health Care
A Supreme Court hearing on a case that could significantly curtail the federal government's regulatory power has big implications for America's health care system. The justices on Wednesday are considering whether to overturn the 40-year-old legal doctrine known as the "Chevron deference," in which the courts have given leeway to federal agencies to reasonably interpret ambiguous laws or ones subject to multiple interpretations. (Millman, 1/17)
