Prior Authorization: On Jan. 17, CMS issued a final rule requiring Medicare Advantage, Medicaid and Marketplace plans to improve their prior authorization processes by 2026. This rule requires these insurers to provide explicit reasons for denials, disclose specific prior authorization statistics and, with the exception of Marketplace plans, issue decisions within 72 hours for urgent cases and seven calendar days for standard ones. Additionally, the rule introduces technology standards to facilitate the exchange of information from these payers to both network providers and patients. It requires the establishment of electronic prior authorization processes by Jan. 1, 2027.
CLIA: The Dec. 28, 2023 final rule by CMS and the CDC increases Clinical Laboratory Improvement Amendments (CLIA) certificate fees by 18 percent and implements additional fees for revised and replacement certificates, complaint-related surveys and deficiency follow-up surveys. Under CLIA, laboratories performing tests on human specimens for diagnosis, prevention, or treatment assessment — including medical and dental offices — must obtain certification based on testing complexity, with waivers available for simple, low-risk tests like INR and blood glucose. Additional information on the CLIA program is available at CMS.gov.
