Yesterday, Health and Human Services (HHS) Secretary Robert Kennedy, and Dr. Mehmet Oz, Administrator for Centers for Medicare & Medicaid Services (CMS) joined forces pledging to streamline the authorization processes for Medicare, Medicaid, the Health Insurance Marketplace, and commercial plans that in which a majority of Americans participate.
The joint venture between the two figure heads will roughly impact 80% of insured Americans according to a press release from HHS.
Here’s a snapshot of what it all means:
U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz today met with industry leaders to discuss their pledge, links to an external website, opens in a new tab 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 aimed at cutting red tape, accelerating care decisions, and enhancing 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.
“Thank you to the insurance companies for making these commitments today. Americans shouldn’t have to negotiate with their insurer to get the care they need,” said RFK, Jr.
“Pitting patients and their doctors against massive companies was not good for anyone. We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”
“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” said Dr Oz.
“We applaud these voluntary actions by the private sector, which is how these types of issues should be solved. CMS will be evaluating progress and driving accountability toward our shared goals, as we continue to champion solutions that put patients first.”
With the new changes outlined, the major insurers have committed to the following:
- 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.
The move is significant for all Americans as this is a rare instance when health insurance providers appear more invested in the overhaul process.
Insurers have become more vested in the process of making things more streamlined ever since the December 2024 murder of UnitedHealthcare CEO Brian Thompson in New York.
Thompson’s alleged killer, Luigi Mangione, was denied a procedure that would have improved his quality of life.
According to some polls, 40% of Gen Z support Mangione, saying that his actions were justified under the circumstances, the insurance provider CEOs are making very public moves to ensure Americans see their commitment to change, and that they will do what is within their power to see it done.