Saturday, April 18, 2026

UnitedHealthcare announced it is removing prior authorization requirements for most medical services for members in rural counties. The policy is part of a new 'rural health financial stability program' and applies to both commercial and Medicare Advantage plans. The move responds to widespread criticism that PA creates dangerous care delays in areas with provider shortages. For practices with UHC patients in qualifying rural ZIP codes, this change is effective immediately. Verify patient eligibility and check UHC's provider portal for your county's status; this should reduce administrative burden and speed up scheduling for affected patients.

CMS published a proposed rule requiring Medicare Advantage, Medicaid managed care, and ACA exchange plans to implement electronic prior authorization for Part D drugs. The rule mandates decisions within 7 calendar days for standard requests and 72 hours for expedited requests, aiming to standardize and streamline a fragmented process. It also requires plans to publicly report PA metrics. This is the agency's most significant move to regulate drug PA timelines. The comment period is open; track CMS-2025-XXXX for the final rule.

CMS and the FDA jointly launched the RAPID Coverage Pathway, a new pilot program designed to accelerate Medicare coverage for FDA-designated breakthrough devices. The pathway aims to synchronize FDA approval and CMS national coverage determination, potentially reducing the typical multi-year coverage lag. For practices that implant or use advanced devices, this signals that coverage for new technologies like certain AI-based diagnostics or novel implants could arrive faster. Monitor the CMS website for the list of initial devices included in the pilot; it may affect procurement and patient counseling decisions later in 2026.

CMS and the FDA announced a new joint coverage pathway named RAPID to expedite Medicare coverage for FDA-designated breakthrough medical devices. The voluntary pathway aims to synchronize FDA approval with CMS coverage decisions, potentially reducing the typical lag between market authorization and reimbursement. The agencies are seeking public feedback on the proposal through June 2026. For practices performing procedures with novel devices, this could mean faster patient access and fewer coverage denials for technologies like advanced prosthetics or neuromodulation devices. Monitor the joint CMS-FDA docket CMS-2026-XXXX for the final rule expected later this year.

Democratic Representatives Pramila Jayapal and Ro Khanna introduced legislation to prohibit the use of prior authorization for any item or service covered under Medicare Advantage plans. The bill, aimed at reducing administrative burdens and care delays, comes amid a regulatory push by CMS to streamline prior authorization processes across MA and other programs. While its passage in the current Congress is uncertain, the proposal signals intensifying political pressure on MA plans and could influence CMS's ongoing rulemaking on electronic prior authorization and response timelines. Track the bill's progress as a barometer for potential future CMS policy tightening.