U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz have engaged with industry leaders to address issues in the prior authorization system for various health plans covering a significant portion of Americans. The meeting, held in Washington, D.C., saw health insurers commit to six reforms aimed at reducing bureaucracy, speeding up care decisions, and increasing transparency.
Companies such as Aetna, Inc., Blue Cross Blue Shield Association, and UnitedHealthcare participated in the roundtable discussion hosted by HHS. Secretary Kennedy expressed gratitude towards these companies for their commitments, emphasizing the need to simplify the process for obtaining prior authorizations for services like diagnostic imaging and outpatient surgery.
Administrator Oz highlighted that these commitments are a positive step toward restoring trust and easing burdens on healthcare providers while ensuring timely patient care. He noted that CMS will monitor progress and hold parties accountable to shared goals.
The insurers pledged to standardize electronic submissions using Fast Healthcare Interoperability Resources (FHIR), reduce medical services requiring prior authorization by 2026, honor existing authorizations during insurance transitions, enhance decision transparency, expand real-time responses by 2027, and ensure clinical denials are reviewed by medical professionals.
Senator Roger Marshall praised the initiative as an important development led by Secretary Kennedy and President Trump. Congressman Greg Murphy also commended the efforts to reform a system he described as obstructive based on his experience as a physician.
These private sector initiatives align with ongoing CMS regulatory efforts to improve interoperability within Medicare Advantage and other plans. CMS remains open to further regulatory actions if necessary.
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