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Prior Authorization Program Extended

October 14, 2019

In September, CMS published a notice in the Federal Register that it would extend the prior authorization demonstration program for another year.

The extension will be restricted to the states where the program was in effect during 2019, which includes Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia, as well as the District of Columbia.

This latest extension will ensure the program runs through December 1, 2020.

All indications are CMS intends to continue to push toward nationwide expansion, which implies CMS believes the demonstration has met the statutory requirements for expansion under the Medicare Access and CHIP Reauthorization Act of 2015.

However, CMS also indicated that it would use 2020 to continue to explore whether the program helps reduce expenditures while maintaining or improving the quality of care offered to beneficiaries.

Click here to visit the CMS site and learn more about the program.

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