Axios Pro Exclusive Content

CMS proposal could shake up lame-duck discussions

Dec 6, 2022
Illustrator of a doctor holding a clipboard and stethoscopes arranged in a radial pattern.

Illustration: Allie Carl/Axios

Medicare Advantage plans and other public health insurance payers would have to implement automated prior authorization systems under a rule proposed by CMS on Tuesday.

Why it matters: The proposed regulation is expected to halve the cost of a popular bipartisan bill that would streamline Medicare Advantage prior authorization policies because of how CBO factors proposed rules into its cost estimates, staffers and lobbyists said prior to the rule's release.

  • We heard last month that the bill’s more than $16 billion price tag could keep it out of the year-end omnibus package, but advocates hope the regulation’s cost-cutting effect can breathe new life into the bill.
  • The proposed rule would also require plans to report prior authorization metrics and send authorization decisions for urgent requests within 72 hours.

Reality check: A 50% cut from the bill’s $16 billion CBO score is still a hefty $8 billion.

Go deeper