(Jan. 26, 2024) – CMS Releases Interoperability and Prior Authorization Final Rule
The Centers for Medicare & Medicaid Services finalized a rule that advances interoperability and improves prior authorization processes for Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program Fee-for-Service programs, Medicaid managed care plans, CHIP managed care entities and Qualified Health Plan issuers on the Federally Facilitated Exchanges. The major sections of changes include the following:
- Decreases the turnaround time between prior authorization requests and insurer determinations from 14 days to seven days for standard requests, as well as 72 hours for urgent requests
- Public reporting of prior authorization metrics on the insurer's website
- Includes certain prior authorization details through Patient Access, Provider Access, Insurer-to-Insurer and Prior Authorization application programming interfaces
MACPAC Releases 2024 Data Book on Medicare/Medicaid Dual Eligibles
The Medicaid and Children's Health Insurance Program Payment and Access Commission published the 2024 data book on dual eligibles. The data book compiles a broad range of data on so-called "duals," Medicare participants who meet Medicaid's income eligibility standards, as well as a compendium of the laws and policies that provide for their coverage.
CMS Releases CY 2024 OQR Payment Determination Lists
Now available on QualityNet are the calendar year 2024 Hospital Outpatient Quality Reporting Program payment determination lists. A total of 2,933, or 95.8 percent of the 3,062 eligible hospitals required to participate in the Hospital OQR program, met all requirements and will receive the full CY 2024 annual payment update. A total of 129, or 4.2 percent of eligible hospitals that failed to meet all OQR requirements or chose not to participate, will receive a reduction of 2.0 percentage points to their CY 2024 annual payment update under the outpatient prospective payment system.
Congress Enacts Another Continuing Resolution
Congress enacted another short-term continuing resolution to fund the federal government through March 1 and March 8. The law extends the current CR from Jan. 19 to Mar. 1 for Agriculture, the Food and Drug Administration, Energy and Water, Military, Construction and VA, Transportation, Housing and Urban Development. The law extends funding for the United States Department of Health and Human Services through March 8. The law also further delays Medicaid disproportionate share hospital funding reductions through March 8.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews: