HHS, CMS announce pledge from insurers to improve MA authorization process

U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz met on Monday with industry leaders to discuss their pledge to streamline and improve the prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace and commercial plans covering nearly eight out of 10 Americans. Participating health insurers have pledged to: Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources-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, and; Ensure medical professionals review all clinical denials. Companies represented at the roundtable included Aetna (CVS), AHIP, Blue Cross Blue Shield Association, CareFirst BlueCross BlueShield, Centene Corporation (CNC), The Cigna Group (CI), Elevance Health (ELV), GuideWell, Highmark Health, Humana (HUM), Kaiser Permanente, and UnitedHealthcare (UNH).