Beginning primarily in 2026, affected payers will be required to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests for medical items and services. For some payers, this new timeframe for standard requests cuts current decision timeframes in half. The rule also requires all affected payers to include a specific reason for denying a prior authorization request, which will help facilitate resubmission of the request or an appeal when needed. Finally, affected payers will be required to publicly report prior authorization metrics.

The rule also requires payers to implement a programming interface to automate the end-to-end prior authorization process. Together, these new requirements for the prior authorization process will reduce administrative burden on the health-care workforce, empower clinicians to spend more time providing direct care to their patients and prevent avoidable delays in care for patients, according to CMS.

Related: How CMS's proposed rule will speed up the prior authorization process

"CMS is committed to breaking down barriers in the health-care system to make it easier for doctors and nurses to provide the care that people need to stay healthy," CMS Administrator Chiquita Brooks-LaSure said. "Increasing efficiency and enabling health-care data to flow freely and securely between patients, providers and payers, and streamlining prior authorization processes supports better health outcomes and a better health-care experience for all."