CMS will launch a voluntary pilot in 2026 to gather service-level data on prior authorization determinations and appeals in Medicare Advantage, according to a Dec. 16 memo.
After the pilot, the agency expects to expand the data-collection efforts to all plans in 2027.
“Beginning the collection as a pilot will allow CMS to gather lessons learned and ensure efficient and accurate reporting of data upon launch of the full-scale collection,” the memo said.
The pilot’s first round of data collection will take place in late 2026, giving insurers six months to prepare. Health plans will need to report several data points, ranging from turnaround times to decision rationales to places of service. Participants will also document whether a third-party vendor weighed in on the decision.
The move builds on a June roundtable meeting with health insurers aimed at streamlining prior authorization. Health plans can indicate their interest in participating by Jan. 9.
