Growing concerns over delays and denials of medical treatment have prompted reforms to MAO prior authorization practices.

CMS 2024 policy and technical changes are intended to streamline the process and increase transparency of the metrics being used by plans in for coverage determinations.

This session will cover notable changes, legal and business considerations for MAOs including:

• Overview of new limits on prior authorization use
• Coverage determination rules
• CMS Two Midnight Rule for inpatient services
• Ensuring plan policies comply with LCDS/NCDs
• Examining the current and future state of gold carding laws and plan programs
• Creating a utilization management committee