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Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a final rule that makes important reforms in prior authorization (PA) programs for medical services. The rule addresses Prior Authorization in government-regulated health plans: Medicare Advantage, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs).
The AMA has provided a detailed, preliminary summary of the new regulations. You can find that summary here.
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