On Wednesday, April 5, 2023, the Centers for Medicare and Medicaid Services (CMS) issued the Medicare Advantage (MA) final rule related to prior authorization in MA plans, more formally known as the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly. The rule finalized changes to prior authorization processes including: requiring plans to keep authorizations valid as long as medically necessary and requiring Medicare Advantage plans to follow existing Medicare national and local coverage determinations (NCDs and LCDs).  

SCAI applauds CMS for taking these initial steps and urges CMS to continue to reform prior authorization through the rule-making process. 

SCAI continues to push for passage of the Improving Seniors’ Timely Access to Care Act to reform the Medicare Advantage prior authorization process more completely.