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On June 23, US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, MD, met with industry leaders representing various health insurance markets—including Medicare Advantage, Medicaid managed care, and commercial plans—regarding a aimed at increasing transparency and reducing administrative burdens associated with prior authorization. Such reforms, spearheaded by America's Health Insurance Plans (AHIP), are intended to:

• Standardize the electronic submission of prior authorization requests
• Limit the scope of claims subject to prior authorization
• Honor other insurers’ prior authorizations for in-network services for 90 days to ensure continuity of care when patients switch plans during ongoing treatment
• Provide simple explanations and easy-to-access assistance for prior authorization determinations
• Accelerate the percentage of prior authorization requests answered in real-time when submitted electronically
• Ensure that prior authorization denials based on medical necessity for clinical factors will be reviewed by a qualified clinician

During a press conference after the meeting, federal health officials pledged that the system will be significantly better by the end of 2025.

The ACShas long expressed concerns about the many disruptions to care, coverage, and payment caused by insurers’ ongoing use of erroneous prior authorization requirements and has been a leading advocate in urging insurers, Congress, and the Administration to make meaningful changes to the implementation and oversight of such requirements.

The College continues to support the passage of the Improving Seniors’ Timely Access to Care Act, which would codify many of the policies included in AHIP’s reform strategy into federal law. Urge your elected officials to by using our SurgeonsVoice advocacy center. It takes only a few minutes with our pre-written correspondence.

Contact lfoe@facs.org with questions.