Utilization management and prior authorization: regulatory and accreditation changes
Last checked: . 3 entries.
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· Centers for Medicare & Medicaid Services
Full title: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; and Quality Reporting Programs; including the Hospital Outpatient Quality Reporting Program and Ambulatory Surgical Center Quality Program; Request for Information on Strengthening the Standardization and Comparability of Hospital Price Transparency (HPT) Data; Prior Authorization; Accrediting Organization (AO) Deeming for Emergency Medical Treatment and Labor Act (EMTALA); and Notices of Closure of Teaching Hospitals and Opportunities To Apply for Available Slots (Final rule with comment period; FR Doc. 2026-22739)
Centers for Medicare & Medicaid Services states: “This final rule with comment period revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2027 based on our continuing experience with these systems.”
Related IHS services: Hospital Price Transparency Compliance Program: 45 CFR Part 180 · EMTALA Compliance Program for Hospitals
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Electronic Prior Authorization: Employers Back Expansion to Self-Funded Health Plans
· Centers for Medicare & Medicaid Services
Centers for Medicare & Medicaid Services states: “More patients and doctors could spend less time navigating faxes, phone calls, and paperwork as leading employers work to expand electronic prior authorization for their self-funded health plans. CMS and the U.S. Department of Labor announced that 5 leading employers have signed a statement of support to make the technical improvements and other capabilities being developed through the 2025 Prior Authorization Pledge available to employers that sponsor self-funded health plans.”
Related IHS services: NCQA Health Plan Accreditation Consulting · URAC Health Plan Accreditation Consulting · URAC Health Plan with LTSS Accreditation Consulting · URAC Health Plan Accreditation for Small Business
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Leading Employers Back Expansion of Electronic Prior Authorization to Self-Funded Health Plans
· Centers for Medicare & Medicaid Services
Centers for Medicare & Medicaid Services states: “More patients and doctors could spend less time navigating faxes, phone calls, and paperwork as leading employers work to expand electronic prior authorization for their self-funded health plans. The Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Labor (DOL) today announced that five leading employers have signed a statement of support to make the technical improvements and other capabilities being developed through the 2025 Prior Authorization Pledge available to employers that sponsor self-funded health plans.”
Related IHS services: NCQA Health Plan Accreditation Consulting · URAC Health Plan Accreditation Consulting · URAC Health Plan with LTSS Accreditation Consulting · URAC Health Plan Accreditation for Small Business
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All accreditors, agencies and topics: Standards changes. Entries quote or report what the authorities published; they are not legal advice and do not interpret the changes.