Reforming Prior Authorization Process: Federal and Pennsylvania

Tucker Arensberg, P.C.
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Tucker Arensberg, P.C.

Both the federal government and the Pennsylvania state government are taking steps to reform the prior authorization process.  Attached is the Pennsylvania Insurance Department Press Release, issued November 3, 2022, touting the passage and signing of Pennsylvania Act 146, which is described as creating a new and more effective process for prior authorization review.

Pennsylvania Act 146 is not intended to take effect until January 1, 2024, so there should be adequate time to review and implement the 50 page statute.

Alone a similar vein, CMS has proposed to expand access to health information and improve the prior authorization process.

Attached are the CMS Press Release announcing that effort along with the CMS Fact Sheet describing the process.

Note that the process is a continuation of a rule that was first introduced in December of 2020.  A revised proposed rule has been issued.  Comments are due by March 13, 2023.  Additional information is available on the CMS website.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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