A new CMS proposed rule would reduce the burden of prior authorizations by further shortening payer decision timeframes and increasing transparency, but still does not go far enough, according to the American College of Rheumatology.
Following up on its 2024 proposed rule reforming prior authorizations, which introduced a 72-hour timeframe for expedited requests and 7 days for standard requests, CMS’ 2026 proposed rule would tighten those windows to 24 hours for expedited requests and 72 hours for most others. In addition, the new rule would apply to payers across CMS programs, including