CMS finalizes rule addressing Medicare Advantage marketing, prior authorization

CMS issued a final rule April 5 that, among other things, aims to streamline Medicare Advantage and Part D prior authorizations and clamp down on misleading marketing practices.

The rule requires that coordinated care plan prior authorization policies may only be used to confirm the presence of diagnoses or other medical criteria and/or ensure that an item or service is medically necessary, according to a CMS fact sheet.

It also requires coordinated care plans to provide a minimum 90-day transition period when a beneficiary undergoing treatment switches to a new MA plan, according to the fact sheet. During this period, the new plan cannot require prior authorization for the active course of treatment.

Source: https://www.beckerspayer.com/policy-updates/hhs-finalizes-rule-addressing-medicare-advantage-marketing-prior-authorization.html