HHS Secretary and CMS Administrator Commit to Prior Authorization Reforms

They announced major private-sector pledges to reduce delays and burdens in health coverage approvals.

Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz met with leading health insurance companies last month to facilitate a new industry pledge that will improve the prior authorization process across Medicare Advantage, Medicaid Managed Care, and commercial plans. Insurers agreed to implement six reforms, which consist of standardizing electronic systems, reducing required authorizations, ensuring continuity of care during insurance changes, improving communication on approvals and denials, expanding real-time responses by 2027, and requiring clinicians to review all medical denials.

These commitments, made by major insurers such as UnitedHealthcare, Kaiser Permanente, and Humana, are part of a broader effort to reduce bureaucratic barriers and enhance timely access to care.

“Pitting patients and their doctors against massive companies was not good for anyone. We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery,” said Secretary Kennedy.

Dr. Oz highlighted that CMS will monitor progress and ensure accountability. The changes are intended to support ongoing regulatory initiatives and respond to long-standing issues within the healthcare system regarding delays and denials in care access.

As the Lord Leads, Pray with Us…

  • For Secretary Kennedy to receive God’s wisdom as he heads the Department of Health and Human Services.
  • For Administrator Oz to be discerning as he oversees the Centers for Medicare and Medicaid Services.
  • For U.S. health officials as they seek to ensure coverage for prescription medications.

Sources: Department of Health and Human Services

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