While CMS rules won’t take full effect until 2026–2027, state-level protections are moving now, and SNFs should assess which new laws apply to their payer mix. For SNFs, these reforms could reduce authorization friction on admissions and continued-stay reviews, particularly in states that restrict AI decision-making tools and mandate auto-approval when insurers miss response deadlines.
However, most state reforms apply to the commercial market, not Medicare Advantage directly, meaning federal enforcement gaps remain a real operational risk for post-acute payer contracting.
Prior Authorization Reform Heats Up
“Process reforms designed to streamline procedures and shorten approval timelines, along with substantive reforms intended to ensure more evidence-based determinations, represent meaningful progress. Nonetheless, with most ambitious reforms happening at the state level, patients’ experiences will continue to vary widely based on where they live and the type of coverage they hold.”
— Health Affairs Forefront, November 24, 2025
As CMS Grapples With Prior Authorization, States Step Into the Void
“AI has been a major concern for skilled nursing providers and their patients, who have frequently [had] SNF admission denied or length-of-stay dictated by MA algorithms rather than a physician’s judgment. A Senate report late last year accused three major MA insurers of specifically targeting post-acute care denials to cut costs and refusing skilled nursing stays nine times more often after adopting AI tools.”
— McKnight’s Long-Term Care News, December 1, 2025
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