The U.S. Health and Human Services (HHS) announced that Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz received a pledge from industry leaders “to streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace and commercial plans.”
Health insurance companies “pledged six key reforms aimed at cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers.”
The companies will:
- “Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR)-based application programming interfaces.
- Reduce the volume of medical services subject to prior authorization by January 1, 2026.
- Honor existing authorizations during insurance transitions to ensure continuity of care.
- Enhance transparency and communication around authorization decisions and appeals.
- Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
- Ensure medical professionals review all clinical denials.”
