Proposed Medicare rule would shorten prior auth wait, require transparency

CMS has issued a proposed rule aiming to cut the maximum decision time for Medicare Advantage prior authorizations from 14 days to 7 calendar days for standard requests, and from 72 hours to 24 hours for expedited requests. The rule, detailed in a notice from the Texas Medical Association, would also mandate that MA plans disclose their prior auth criteria publicly and report denial rates annually. This move addresses widespread provider complaints about delays in care and opaque decision-making. The proposed changes are subject to a public comment period before finalization. Practices should monitor CMS-2026-XXXX for the final rule and begin tracking current auth turnaround times to prepare for the potential shift.