CMS proposed tightening prior authorization timelines to 24 hours for urgent requests and 72 hours for standard ones, but the American College of Rheumatology says the rule still has major gaps. While physicians broadly support the direction, only 33% believe voluntary insurer pledges will make a real difference. Key concerns include vague denial reasons, excluded state-based exchange plans, and Medicare Part D being left out of the new interoperability framework.
CMS's 2026 proposed rule takes another swing at reforming prior authorization — tightening decision windows to 24 hours for urgent requests and 72 hours for standard ones, expanding transparency requirements, and making it easier to transfer EHR documentation directly to payers. The American College of Rheumatology (ACR) applauded the effort but made clear it doesn't go far enough, particularly for patients with rheumatic and autoimmune diseases where treatment delays can cause permanent organ damage.
The ACR's concerns are echoed across the broader physician community. An AMA survey of 1,000 physicians found that only 33% believe insurer pledges to reform prior authorization will lead to meaningful change — and for good reason. Physicians complete an average of 40 prior auth requests per week, with 32% often or always denied. Meanwhile, CMS's AI-powered WISeR pilot program has actually lengthened wait times to 10–15 days in some cases.
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Why it matters: Prior authorization delays aren't just administrative headaches — they can derail treatment for patients with serious conditions. The ACR is pushing CMS to close loopholes (like excluding state-based exchanges and Medicare Part D) and demand clearer denial criteria so physicians can actually act on them.
