CMS Wants To Speed Up Prior Authorization Decisions For Rx Drugs
Health insurance companies and states would also have to publicly disclose their denial rates for meds. Meanwhile, Medicare enrollees will soon have access to a digital health record system, enabling them to share records with providers.
Health insurance companies and states would have to resolve prior authorization requests for drugs more quickly and publicly disclose their denial rates under a proposed rule the Centers for Medicare and Medicaid Services published Friday. The regulation would require Medicaid and Children’s Health Insurance Program insurers, along with state Medicaid and CHIP administrators, to respond to non-urgent prior authorization requests for prescription drugs within 24 hours after receiving a request. (Tepper, 4/10)
Medicare enrollees will soon be able to export their medical records to their doctor or hospital under a program launched Thursday by CMS. "Right now, our health information still feels stuck in the past," Amy Gleason, acting administrator of the Department of Government Efficiency and a senior advisor at HHS, said in a press conference with reporters. (Frieden, 4/10)
Medicare payments for inpatient hospital services would rise 2.4% in fiscal 2027 under a proposed rule the Centers for Medicare and Medicaid Services issued Friday. CMS also proposed reviving and scaling up its Comprehensive Care for Joint Replacement payment model across the nation beginning in 2027. The revived CJR model, which CMS has dubbed CJR-X, would be the first nationwide mandatory episode-based payment model in fee-for-service Medicare, according to an agency news release. (Early, 4/10)
More news on the Trump administration —
The Honduran family of an 8-year-old girl with a heart condition who died in U.S. custody after crossing the border in 2023 sued the federal government on Friday. Anadith Danay Reyes Alvarez, who had chronic heart problems and sickle cell anemia, got sick with flu-like symptoms and died after being detained for eight days in a U.S. Customs and Border Protection facility in Donna, then later Harlingen, Texas. (Gonzalez, 4/10)
White House budget director Russ Vought isn’t done trying to cut the National Institutes of Health’s funding, but Congress isn’t taking him seriously anymore. Vought released a proposal last week to slash the 2027 budget for the world’s largest funder of health research by 10 percent, down from 40 percent last year. It’s unlikely Congress or the agency’s head will listen to him. Lawmakers rejected Vought’s first big cut in the spending bill they passed in February and already promised to reject the smaller one this year. (Hooper, 4/11)
Highly trained service members have been put on paid leave for nearly a year as they wait for the military to decide their fate. (Phillipps, 4/13)
On a serene Saturday afternoon, thousands of miles from conflict, soldiers with the California Air National Guard are scattered among stations, hunched over a buddy. Some apply tourniquets. Others practice life-saving skills, checking for breathing, tilting chins to clear airways, searching for blood loss and hidden wounds. This is how they learn to keep a soldier alive. (Krieger, 4/12)
