WASHINGTON, D.C. – On June 23, HHS Secretary Kennedy and CMS Administrator Oz announced a new industry pledge from major health insurers to reform the prior authorization process across Medicare Advantage, Medicaid Managed Care, Open Enrollment Marketplace, and commercial plans.

Participating insurers committed to reforms aimed at improving efficiency and transparency:

• Standardizing electronic prior authorization, with a goal of making this new system operational by Jan. 1, 2027.
• Reducing the scope of claims requiring prior authorization, with demonstrated reductions by January 1, 2026.
• Ensuring continuity of care when patients change plans– Beginning Jan. 1, 2026, when a patient changes insurance companies during a course of treatment, the new plan will honor existing prior authorizations for benefit-equivalent in-network services as part of a 90-day transition period.
• Enhancing communication and transparency on determinations– Health plans will provide clear, easy-to-understand explanations of prior authorization determinations, including support for appeals and guidance on next steps.
• Expanding real-time responses– In 2027, at least 80% of electronic prior authorization approvals will be answered in real-time.
• Ensuring medical review of non-approved requests– Participating health plans affirm that all non-approved requests based on clinical reasons will continue to be reviewed by medical professionals

This initiative has the potential to reduce administrative burdens and improve continuity of care for providers—including those in the DME sector. AAHomecare is watching to see how these voluntary efforts translate into operational changes for the DME community. More detail can be found in announcements from the America’s Health Insurance Plans (including a list of plans signing on to the reforms) and the Dept. of Health & Human Services.