Changes to the Centers for Medicare and Medicare Services (CMS) requirements take effect on January 1, 2026. These changes will impact how payers approach utilization management and supplemental benefits notifications.
Approached with foresight, payers can effectively manage these mandates while enhancing the member experience.
Now is the time for health payers to strategize and meet the moment.
In this webinar, we cover the CMS changes set to arrive in 2026.
Updated utilization management requirements are designed to improve transparency and reduce unnecessary care delays.
Key updates include:
- Shortened timelines for standard (non-urgent) prior authorization decisions.
- Enhanced APIs and multichannel electronic sharing of health information.
- Inclusion of denial reasons in provider and patient notifications.
- Publicly accessible prior authorization metrics.
The new mid-year supplemental benefits notifications mandate requires payers to reach out to members with completely unused supplemental benefits between June 30 and July 31.
This change aims to:
- Reduce the underutilization of supplemental benefits.
- Increase member awareness and engagement.
- Improve health outcomes.
We explore how these changes will affect health plan members and lay out practical steps payers should take sooner rather than later to invest in operational processes and technology that meet these guidelines while forging stronger member bonds.
Watch the webinar to learn how you and your team can confidently navigate upcoming CMS requirements and leverage them as an opportunity to enhance your member experience.