0938-AV44 202504 Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Interoperability Standards and Prior Authorization for Drugs (CMS-0062)

This rule would propose new requirements for Medicare Advantage (MA) organizations, state Medicaid fee-for service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plans (QHPs) offered on the Federally-facilitated Exchanges (FFEs) to streamline processes for the prior authorization for certain drugs.  We are developing this rule, in part, based on the significant number of public commenters who responded to the CMS Interoperability and Prior Authorization proposed rule (87 FR 76238) urging CMS to expand the proposed prior authorization policies to include drugs.

]]> Other Significant Previously Published in The Unified Agenda Proposed Rule Stage No No Other 42 CFR 422 42 CFR 431 42 CFR 438 42 CFR 457 45 CFR 156 42 U.S.C. 1395hh Yes NPRM 09/00/2025 No Federal State No No No Alexandra Mugge Director & Chief Health Informatics Officer, Health Informatics and Interoperability Group 0938 Centers for Medicare & Medicaid Services CMS 410 786-4457 alexandra.mugge@cms.hhs.gov Office of Healthcare Experience and Interoperability, MS: C5-02-00, 7500 Security Boulevard, Baltimore MD 21244