Knowledge Center

Family physicians got several administrative simplification wins in CMS’ Jan. 17 finalization of a long-anticipated prior authorization rule that reflects the AAFP’s staunch advocacy.

As the Academy called for following CMS' December 2022 proposal, the final rule will expand and strengthen the electronic prior authorization system for Medicare Advantage plans, dramatically lessen the decision-making timeframe for prior authorization requests and require payers to more efficiently share clinical and claims data when patients transfer between plans. The rule, which begins rolling out Jan. 1, 2026, governs Medicare Advantage payers, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities and Qualified Health Plan issuers on the federal exchanges.