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Medicaid › Prior Authorization

Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with... more +
Medicaid is a partnership program between states and the federal government to provide healthcare coverage for lower income individuals, people with disabilities, older people, and certain families with children.  less -
DLA Piper

GAO Report Gives MA Organizations and Behavioral Health Providers Food for Thought on Prior Authorization

DLA Piper on

The US Government Accountability Office (GAO) recently released a report on the Centers for Medicare and Medicaid Services (CMS)’s oversight of prior authorization criteria for behavioral health services (BHS) by Medicare...more

Spilman Thomas & Battle, PLLC

The Health Record - Healthcare Law Insights, V 2, Issue 4, April 2025

Spilman Thomas & Battle, PLLC on

Welcome to our fourth issue of 2025 of The Health Record -- our healthcare law insights e-newsletter. In this edition, we look at prior authorization transparency and physician decision-making; the impact of Medicaid cuts...more

McDermott+

CY 2026 MA and Part D Final Reg: Policies Under Consideration

McDermott+ on

Last week, the contract year (CY) 2026 Medicare Advantage (MA) and Part D final reg entered the clearance process at the Office of Management and Budget (OMB). As mentioned in a previous Regs & Eggs blog post, OMB’s review is...more

Mintz - Health Care Viewpoints

California Health Care Legislative Update: Winter 2024

Mintz - Health Care Viewpoints on

Governor Newsom signed over 1300 bills and vetoed almost 190 bills in 2024. Consistent with prior years, in 2024, California enacted multiple laws significantly impacting the health care industry. From artificial intelligence...more

McCarter & English, LLP

New Jersey Statutory Update Part II

McCarter & English, LLP on

Below is Part II of our New Jersey Statutory update. As you can see from the below, several statutes were passed imposing requirements on health insurance payers, including new requirements for prior authorization request and...more

Epstein Becker & Green

Advancing Interoperability and Improving Prior Authorization: No One Said It Would Be Easy!

Epstein Becker & Green on

The Centers for Medicare & Medicaid Services (CMS) recently published the CMS Advancing Interoperability and Improving Prior Authorization Processes Final Rule (“PA Final Rule”) in the Federal Register....more

Smith Anderson

Centers for Medicare & Medicaid Services Issues Interoperability and Prior Authorization Final Rule

Smith Anderson on

As part of its ongoing mission to modernize and improve the interoperability of the health care system, on January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior...more

McDermott Will & Emery

Healthcare Regulatory Check-Up Newsletter | January 2024 Recap

McDermott Will & Emery on

This issue of McDermott’s Healthcare Regulatory Check-Up highlights regulatory activity for January 2024. We discuss several US Department of Health and Human Services (HHS) agency actions, including the new Innovation in...more

King & Spalding

CMS Issues Final Rule Aimed at Improving Prior Authorization Processes

King & Spalding on

On January 18, 2024, CMS released a pre-publication version of a final rule (the Final Rule) that will require Medicare Advantage organizations (MA or Part C), Medicaid and the Children’s Health Insurance Program (CHIP)...more

Cozen O'Connor

CMS Issues Final Rule Impacting Prior Authorization Process

Cozen O'Connor on

Last week CMS issued its final rule “CMS Interoperability and Prior Authorization” (CMS-0057-F), unchanged from its proposed rule in 2022, which addresses prior authorizations. Prior authorization, a “utilization management”...more

Groom Law Group, Chartered

CMS Proposed Rule Would Leverage Technology and Interoperability to Improve Prior Authorization

Groom Law Group, Chartered on

On Tuesday, December 13, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“New Proposed Rule”) to improve the prior authorization process and advance interoperability for Medicare Advantage...more

Holland & Knight LLP

Holland & Knight Health Dose: December 13, 2022

Holland & Knight LLP on

Holland & Knight Health Dose is an in-depth weekly dose of legislative and regulatory insights to keep stakeholders abreast of happenings in Washington, D.C., impacting the health sector. This week's topics include: ...more

Harris Beach Murtha PLLC

OIG Enforcement Summary: July 16, 2022 – July 31, 2022

Harris Beach Murtha PLLC on

The following is a summary of the federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported are...more

Bricker Graydon LLP

Medicare to require prior authorization for certain outpatient department services starting July 1, 2020

Bricker Graydon LLP on

In the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (2020 OPPS Final Rule), the Centers for Medicare and Medicaid Services (CMS) established a prior authorization process and...more

Bass, Berry & Sims PLC

CMS Rapidly Approves Section 1135 Waivers in Response to the COVID-19 Pandemic - Update

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This content was last updated as of Thursday, April 24 at 12:00 p.m. CST- The Centers for Medicare & Medicaid Services (CMS) continues its issuance of Section 1135 waivers, waiving or modifying certain Medicare, Medicaid,...more

Bass, Berry & Sims PLC

CMS Rapidly Approves Section 1135 Waivers in Response to the COVID-19 Pandemic

Bass, Berry & Sims PLC on

The Centers for Medicare & Medicaid Services (CMS) continues its issuance of Section 1135 waivers, waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that...more

Holland & Hart - Health Law Blog

CMS Expands Blanket Waivers to Help Hospitals and Other Providers

Holland & Hart - Health Law Blog on

On March 30, 2020, CMS issued numerous additional blanket waivers to give providers greater flexibility in responding to COVID-19. (See https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf)....more

Robinson+Cole Health Law Diagnosis

CMS grants Massachusetts Section 1135 Waiver, DPH issues Guidance regarding Determination of Need and Nurse Staffing Requirements,...

Robinson+Cole Health Law Diagnosis on

In this article, we highlight additional updates issued by state and federal government authorities for the health care community in Massachusetts related to COVID-19....more

Baker Donelson

CMS Seeks Additional Ideas for Reducing Administrative Burdens in Health Care

Baker Donelson on

The Centers for Medicare & Medicaid Services (CMS) has issued a Request for Information (RFI) focused once again on reducing the administrative burden for physicians by reviewing and revising regulations. The RFI, published...more

Spilman Thomas & Battle, PLLC

Update on the West Virginia Legislature - Crossover Day, Issue 8

Spilman Thomas & Battle, PLLC on

We are now approaching crossover day, February 27, the date that bills must pass their house of origin in order to be considered by the other house during the remainder of the legislative session. As a practical matter, if a...more

Williams Mullen

Attention: All Medicaid Providers Whose Services Require Prior Authorization

Williams Mullen on

A Way to Increase Revenue and Help Medicaid Recipients - Have you heard the cliché: “Killing two birds with one stone….?” The phrase is thought to have originated in the early 1600s when slingshots were primarily...more

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