Daily Briefing

Around the nation: CMS hints at more prior authorization rules


CMS Administrator Chiquita Brooks-LaSure on Monday suggested that the agency may take further steps to crack down on health insurance companies' prior authorization requirements, in today's bite-sized hospital and health industry news from the District of Columbia, Illinois, and Rhode Island.

  • District of Columbia: CMS Administrator Chiquita Brooks-LaSure on Monday suggested that the agency may take further steps to crack down on health insurance companies' prior authorization requirements. During the American Hospital Association's annual conference, Brooks-LaSure acknowledged both patient and provider frustrations with prior authorizations. "The volume of frustration that I hear about prior authorization has just exploded, and I think it is really at a point where it is affecting care and our workforce in a way that is extremely problematic," she said. Brooks-LaSure said she believes CMS has "taken some really important steps in our rules" and said the agency wants "to continue to look and hear about how things are operating. I've been hearing a lot about prescription drugs. That's an area that we have been asked to look at, and we are open to do that." (McAuliff, Modern Healthcare, 4/15)
  • Illinois: VillageMD has named Jim Murray as its president and COO, effective April 1. Murray is tasked with leading operations, including those of Village Medical, Summit Health, and CityMD. Murray most recently served as COO and chief transformation officer of Centene, and previously served as president and COO of Magellan Health. (DeSilva, Modern Healthcare, 4/10)
  • Rhode Island: CVS Health said it will open Oak Street Health primary care clinics at its retail pharmacy stores. CVS acquired Oak Street in May for $10.6 billion and announced that it planned to add 50 to 60 Oak Street clinics in 2024. Most of those clinics are expected to be standalone locations; however, CVS is piloting a setup that will replace much of the retail space in its existing stores with clinics. "This is not some new model that we hope will work right and we're going to expand very quickly," said Mike Pykosz, co-founder of Oak Street and president of healthcare delivery at CVS. "This is a model that we know works because we've been doing this for over 10 years." (Hudson, Modern Healthcare, 4/16)

How BCBS of South Carolina Created a Live Prior-Authorization Tracker

Learn how BCBS of South Carolina created a live prior-authorization tracker to increase transparency and reduce member frustration.


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