June 30, 2025
Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., and CMS Administrator Dr. Mehmet Oz recently met 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.
In a roundtable discussion hosted by HHS, health insurers pledged six key reforms to cut red tape, accelerate care decisions, and enhance transparency for patients and providers. Their commitments reinforce the role of CMS in monitoring outcomes and promoting accountability. Companies represented at the roundtable included Aetna, Inc.; AHIP; Blue Cross Blue Shield Association; CareFirst BlueCross BlueShield; Centene Corporation; The Cigna Group; Elevance Health; GuideWell; Highmark Health; Humana, Inc.; Kaiser Permanente; and UnitedHealthcare.
Participating health insurers have pledged to:
- 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.
These private sector reforms complement CMS' ongoing regulatory efforts to improve prior authorization interoperability within Medicare Advantage, Medicaid Managed Care, and Health Insurance Marketplace®.
CMS noted that it encourages continued innovation and collaboration but reserves the right to pursue additional regulatory actions if necessary.
