CMS Proposes API Mandate for Healthcare Prior Authorization

CMS published two coordinated proposed rules requiring Medicare Advantage organizations, state Medicaid programs, and CHIP managed care entities to implement electronic API-based prior authorization systems. The rules would require payers to respond to prior authorization requests within 72 hours for urgent requests and seven days for standard requests.

The proposed mandate aims to reduce administrative burden on healthcare providers who currently spend hours navigating paper-based authorization processes. Physicians and hospitals have long complained that prior authorization delays treatment and harms patients. Comments on the rules are due June 15, 2026, with implementation timelines to be finalized.