Faster Prior Authorization Deadlines Are Here. Los Angeles Physicians Are Watching Closely, Not Celebrating.

As of January 1, 2026, new federal rules requiring health insurers to make prior authorization decisions more quickly are officially in effect. The changes, finalized by the Centers for Medicare & Medicaid Services (CMS), require payers to issue decisions on urgent requests within 72 hours and standard requests within seven calendar days. Insurers must also provide clearer, more specific explanations when care is denied.

The intent is clear: reduce treatment delays and administrative friction that have long frustrated physicians and patients alike. But across Los Angeles County, physicians are responding with cautious realism rather than optimism. Many see the new requirements as incremental improvements in a system that remains fundamentally misaligned with clinical care.

Prior authorization continues to be a daily operational strain for physicians practicing in one of the nation’s most complex healthcare environments. From independent practices to large health systems, from subspecialists to primary care physicians serving safety-net populations, authorization delays frequently translate into postponed imaging, deferred procedures, interrupted treatment plans, and patient dissatisfaction that physicians must manage.

What the new rules now require

Under the CMS Interoperability and Prior Authorization Final Rule, health plans covering Medicare Advantage, Medicaid managed care, CHIP, and ACA marketplace enrollees must comply with standardized timelines and transparency requirements.

In addition to the faster decision clocks, insurers are now required to:

• Provide detailed clinical rationales when denying care, rather than generic explanations

• Share prior authorization data electronically to improve continuity and reduce duplicative requests

• Publicly report approval rates, denial rates, and average response times

Traditional Medicare is not included in the rule, but its reach is still significant in Los Angeles, where Medicare Advantage enrollment continues to grow, particularly among older adults and communities of color.

Why physicians remain guarded

Despite the rule now being active, many physicians view it as a modest course correction rather than a meaningful fix. National analyses continue to show that a large percentage of denials are ultimately overturned on appeal, suggesting that much of the administrative burden exists to validate care that is clinically appropriate from the start.

For Los Angeles physicians, this dynamic is especially familiar. Practices often dedicate staff hours to managing authorizations that add no clinical value, yet must be pursued to ensure patients receive timely care. Smaller and independent practices, without robust administrative infrastructure, feel this burden most acutely.

Federal oversight agencies have previously raised concerns about inappropriate denials, particularly in Medicare Advantage. Reports from the HHS Office of Inspector General found instances in which plans denied services that met Medicare coverage criteria, highlighting ongoing access risks even under existing regulations.

Adding to physician concern is the expanding role of automation and artificial intelligence in utilization management. While insurers argue that technology can speed decisions, physician organizations worry that automation may simply accelerate denials rather than improve clinical review. Transparency requirements now in place may help surface these patterns, but enforcement will determine whether reporting leads to accountability.

Why this matters in Los Angeles

Los Angeles County physicians practice at the intersection of rising demand, workforce shortages, and widening health inequities. Prior authorization delays disproportionately affect patients with limited resources, unstable housing, language barriers, or complex chronic conditions. When care is delayed, patients may miss follow-up appointments, abandon treatment altogether, or experience avoidable disease progression.

For practices serving Medi-Cal, dual-eligible, and high-risk Medicare Advantage populations, authorization delays are not just an inconvenience. They can undermine continuity of care and erode patient trust, particularly when physicians are perceived as the gatekeepers of insurer decisions they do not control.

What practices can do now

With the rules now in effect, Los Angeles physicians can take concrete steps to protect patients and their practices.

First, treat prior authorization as a time-sensitive clinical workflow. Document submission dates, payer deadlines, and response times. This information is critical now that insurers are subject to regulated timelines.

Second, clearly identify and justify urgent requests. Proper designation can mean the difference between a 72-hour decision and a week-long delay.

Third, use the new denial transparency requirements strategically. Appeals that directly address the insurer’s stated rationale are more effective and less resource-intensive than broad challenges.

Finally, do not hesitate to escalate systemic issues. California’s Department of Managed Health Care provides complaint and Independent Medical Review pathways that remain essential tools when plans fail to comply with state and federal requirements.

Progress, but pressure remains

The implementation of faster prior authorization timelines marks a step forward, but few physicians believe it resolves the core problem. Without reductions in authorization volume, stronger alignment with evidence-based medicine, and consistent regulatory enforcement, prior authorization will remain a significant barrier to timely care.

For Los Angeles physicians, the moment reinforces the value of collective advocacy. Through LACMA+CMA, physicians can continue pushing for reforms that respect clinical judgment, protect patient access, and allow physicians to focus on what matters most: delivering care, not managing delays.