Thursday, February 4, 2021

What's happening to Prior Auth rule?

On January 12, CMS released the MCIT rule, and it was published in the Federal Register on January 14.

On January 15, CMS released the final "prior auth" rule, in inspection-copy form, with a press release.  I believe it has never appeared in the Federal Register, and I learned on February 4 the rule's PDF and the rule's Press Release were deleted from the CMS website.

This is at variance with a January 26 article at Becker's Hospital Review.  That article said that three rules were being withdrawn:

  • Medicare Part A enrollment;
  • Altered dialysis rules;
  • Oversight of accreditation organizations.
But the Becker's article said that three rules would go forward:
  • A rule for prior authorizations,
  • A rule for breakthrough technologies,
  • An update of 'reasonable and necessary' regulations (the 2nd and 3rd points are in one published rule, Fed Reg, Jan 14).
https://www.beckershospitalreview.com/finance/cms-withdraws-3-proposed-health-rules.html

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A drug pricing rule (MFN) is officially delayed for a year; it is tied up in court anyway.
https://khn.org/morning-breakout/biden-administration-delays-trumps-drug-pricing-rebate-rule-for-a-year/


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