HHS and CMS Announce Overhaul of Insurance Approvals to Speed Up Care
HHS, CMS Announce Overhaul of Insurance Approvals to Speed Up Care
Summary
The U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) announced a sweeping initiative to streamline prior authorization processes across both public and private health insurance plans. Major insurers like Aetna and Humana pledged reforms aimed at improving access to care through electronic standardization.
Details
The U.S. Department of Health and Human Services (HHS), led by Secretary Robert F. Kennedy Jr., and the Centers for Medicare & Medicaid Services (CMS), led by Administrator Dr. Mehmet Oz, announced a major initiative to streamline prior authorization processes across public and private health insurance plans. This announcement was made with pledges from leading insurers such as Aetna, Humana, Blue Cross Blue Shield, and UnitedHealthcare. The key reforms include standardizing electronic submissions using FHIR®-based APIs, reducing the number of services requiring prior authorization by 2026, honoring existing authorizations when patients change insurance, and providing real-time responses to most requests by 2027. Secretary Kennedy stated that Americans should not have to negotiate with their insurer for necessary care. These changes aim to reduce administrative burden on providers and improve timely access to evidence-based care across Medicare Advantage, Medicaid Managed Care, the Health Insurance Marketplace, and commercial plans. CMS will evaluate progress and drive accountability toward these shared goals.
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