Virginia CSBs support implementation of the federal prior-authorization improvements, including shorter decision timeframes, specific denial reasons, transparency reporting, and a meaningful reconsideration opportunity. Before Appendix D becomes effective, DMAS should clarify PRTF and TGH coverage and claim routing; establish safeguards for MES and ANG access; define when authorization clocks begin and how extensions operate; require transparent automated criteria and human review before adverse decisions; and protect reconsideration and appeal rights through clear notice, receipt rules, filing confirmations, cure periods, and good-cause exceptions. DMAS should provide a consolidated ARTS authorization crosswalk and at least 90 days for CSBs to update access roles, policies, EHR workflows, training, and compliance controls.