On April 14, 2026, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule aimed at modernizing prior authorization processes and accelerating interoperability across the health care system. The proposal builds on CMS’s prior interoperability efforts and introduces significant new requirements, particularly related to electronic prior authorization (ePA) for drugs. The rule is designed to reduce administrative burden, improve care coordination, and speed patient access to medically necessary therapies by requiring more standardized, electronic data exchange between providers and payers.
Sleep medicine practices routinely navigate prior authorization requirements for diagnostics (for example, HSAT and PSG), durable medical equipment (for example, PAP devices), and medications. CMS explicitly acknowledges that prior authorization delays can negatively affect patient outcomes and create substantial provider burden, reinforcing the need for reform.
If finalized, the proposals in this rule will significantly change how prior authorizations are submitted, tracked, and decided, moving toward a more automated, real-time environment.
Key proposals that may impact sleep medicine include:
- Expansion of electronic prior authorization to drugs
- Mandatory use of standardized application programming interfaces (APIs)
- Real-time access to prior authorization status and requirements
- Requirement for specific denial reasons
- Shortened and standardized timeframes
- Public reporting of prior authorization metrics
- Centralized reporting of API endpoints
- Adoption of interoperability standards under HIPAA
AASM health policy staff will review the proposed rule in its entirety, and comments will be submitted on behalf of the AASM membership by the June 15, 2026, deadline. Questions about this proposed rule can be sent to coding@aasm.org.
