HHS promotes insurer pledge to scale back prior authorization
Federal health officials on Monday touted pledges they have received from the health insurance industry to streamline and reform the prior authorization process for Medicare Advantage, Medicaid Managed Care and Affordable Care Act Health Insurance Marketplace plans which account for most insured Americans.
Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz took part in a roundtable discussion with insurers in which the payers pledged commitments to six key reforms to the prior authorization process.
Health care providers must obtain approval from an insurer before a specific service is covered, and they've criticized that process for being time-consuming and a drag on providing health care.
According to Oz, the roundtable included the CEOs of health insurance companies who cover about 75 percent of Americans. The CMS administrator said he would like fewer services to be subject to preauthorization.
Medicare Director Chris Klomp gave the example of colonoscopies or cataract surgeries as procedures that could be moved out of the prior authorization process.
Referencing the biblical passage that reads “the meek will inherit the earth,” Oz said in a press briefing that health insurance companies and hospital systems have “agreed to sheath their swords, to be meek for a while.”
Major health insurers including Cigna, UnitedHealthcare and Aetna said they would be simplifying the process and reducing the number of health care claims subject to prior authorization.
The voluntary commitments include standardizing the electronic........
© The Hill
