2 Analyses of this federal-register by attorneys

  1. Prior Authorization Reform in Healthcare: Winds of Change?

    Butler Snow LLPSeptember 26, 2023

    of 1945,ch. 20, § 1, 59 Stat. 33 (codified as amended at15 U.S.C. § 1011 (2018)). .See, e.g., Louisiana Health Service & Indemnity Co. v. Rapides Healthcare System, 461 F.3d 529 (5th Cir. 2006) (Louisiana assignment statute held not to have impermissible connection with ERISA plans). 28 Texas Admin. Code § 4201.652 (Applicability of Subchapter). 215 ILCS 200/10 (Applicability; scope). TMA Frequently Asked Questions on Texas’ ‘Gold-Carding’ Preauthorization Exemption Law and Rules, TMA Office of the General Counsel (October 17, 2022), (available at https://www.texmed.org/GoldCardWhitePaper). Centers for Medicare and Medicaid Services, Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule CMS-0057-P: Fact Sheet (December 6, 2022), https://www.cms.gov/newsroom/fact-sheets/advancing-interoperability-and-improving-prior-authorization-processes-proposed-rule-cms-0057-p-fact) (last viewed June 28, 2023); see also Medicare and Medicaid Programs Proposed Changes, 87 Fed. Reg. 76238 (proposed December 13, 2022).Id. (CMS Fact Sheet at 3-4). 87 Fed. Reg. at 76239 (Background and Summary of Provisions). Easing the Prior Authorization Journey, UnitedHealthcare (March 29, 2023), https://newsroom.uhc.com/experience/easing-prior-authorizations.html) (last viewed June 28, 2023). Bob Dylan, Subterranean Homesick Blues, from Bringing It All Back Home (Columbia 1965).Finis

  2. Regs, Regs and More Regs: The Biden Administration Releases Spring 2024 Unified Agenda

    McDermott+ConsultingJeffrey DavisJuly 11, 2024

    ification subtitle of HIPAA. This rule would propose to replace the X12 Technical Reports Type 3, Version 5010 with the X12 Technical Reports Type 3, Version 8020 for healthcare claims or equivalent encounter information transactions (Institutional, Professional and Dental) and electronic remittance advice transactions. These updated versions of the X12 standards would promote interoperability and ease the administrative burden on providers and health plans.December 2024HHS/CMS: Interoperability Standards and Prior Authorization for Drugs (CMS-0062); Proposed Rule Stage; Regulatory number: 0938-AV44CMS would propose new requirements for Medicare Advantage (MA) organizations and qualified health plans offered on the federally facilitated exchanges to streamline processes for the prior authorization for certain drugs. CMS is developing this rule, in part, based on the significant number of public commenters who responded to the CMS Interoperability and Prior Authorization proposed rule (87 FR 76238) urging CMS to expand the proposed prior authorization policies to include drugs.November 2024HHS/CMS: Administrative Simplification: Adoption of Standards for Health Care Attachment Transactions and Electronic Signatures (CMS-0053); Final Rule Stage; Regulatory number: 0938-AT38This rule finalizes new standards for health plans and providers to support both healthcare claims transactions and standards for electronic signatures to be used in conjunction with healthcare attachments transactions. Additionally, this rule finalizes a regulatory change that implements requirements of the Administrative Simplification subtitle of HIPAA and the Patient Protection and Affordable Care Act (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111-152), enacted on March 30, 2010.November 2024HHS/CMS: Administrative Simplification: Modifications to NCPDP Retail Pharmacy Standards (CMS-0056); Final Rule Stage; Regulatory number: 0938-AU19This final rule