New Medicare Advantage Prior Authorization Rules Effective January 1, 2024

The Centers for Medicare & Medicaid Services (CMS) has issued new rules regarding prior authorizations (PAs) for Medicare Advantage (MA) plans.

Prior authorizations for members who transition to another plan.

CMS requires that plans provide a minimum 90-day transition period when an enrollee who is currently undergoing an active course of treatment switches to a new MA plan. This includes treatment from out-of-network providers. A new PA is not required. If you have a patient who currently has an approved PA request but is moving to another plan, their current PA will remain for a minimum of 90 days.

Approved prior authorizations.

CMS also ruled that approved prior authorizations are now valid for as long as medically necessary. This is to help members avoid any disruption in their care.

You can learn more about these changes by reviewing the CMS 2024 final rule.