CMS Releases Proposed Rule To Improve Prior Authorization Processes

Within the 2026 Centers for Medicare & Medicaid Services Interoperability Standards and Prior Authorization for Drugs proposed rule, CMS announced plans to improve prior authorization processes for patients insured through a Medicare Advantage, state Medicaid and Children’s Health Insurance Program fee-for-service programs, Medicaid managed care plans, CHIP managed care entities and Marketplace plans.

CMS is reminding electronic health record vendors to implement application programming interfaces between patients and insurers, providers and insurers and payer to payers by Jan. 1, 2027. Also included is a requirement to develop a provider directory API. CMS is accepting comments until Monday, June 15.