“RFK Jr. Leads Prior Authorization Reform with Major Health Insurers to Improve Patient Access”

Prior authorization reform took a major step forward today as U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. and Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz met with industry leaders to secure commitments for streamlining healthcare processes affecting nearly eight out of ten Americans.

In a roundtable hosted by HHS, major health insurers pledged six core reforms to simplify and accelerate prior authorization decisions across Medicare Advantage, Medicaid Managed Care, the Health Insurance Marketplace®, and commercial plans. These changes are aimed at cutting red tape, improving communication, and ensuring that patients get timely access to care.

The meeting included representatives from major insurers such as Aetna, AHIP, Blue Cross Blue Shield Association, CareFirst, Centene, Cigna, Elevance Health, GuideWell, Highmark Health, Humana, Kaiser Permanente, and UnitedHealthcare.

“Americans shouldn’t have to negotiate with their insurer to get the care they need,” said Secretary Kennedy. “Prior authorization reform is long overdue, and today’s commitments will help ensure that common procedures like diagnostic imaging, physical therapy, and outpatient surgeries are approved more swiftly and transparently.”

Administrator Oz echoed this sentiment, calling the pledges a step toward restoring trust in the healthcare system. “CMS will evaluate outcomes, drive accountability, and ensure that these reforms meet the goal of putting patients first.”

The six key commitments from insurers include:

1. Standardizing electronic prior authorization using FHIR®-based APIs.

2. Reducing the volume of services requiring prior authorization by January 1, 2026.

3. Honoring authorizations during insurance transitions to avoid gaps in care.

4. Improving transparency around decisions and appeals.

5. Expanding real-time approvals, with most requests expected to receive instant decisions by 2027.

6. Requiring clinical reviews for all medical denials.

Members of Congress praised the initiative. Senator Roger Marshall (R-KS) and Congressman Greg Murphy (R-NC) thanked President Trump, Secretary Kennedy, and Dr. Oz for advancing reforms that doctors and patients have long demanded.

“As a physician for over 30 years, I’ve seen firsthand the damage these bureaucratic delays cause,” said Rep. Murphy. “This collaboration is a major win for healthcare access and efficiency.”

These voluntary efforts align with CMS’s ongoing regulatory efforts to improve interoperability and patient outcomes. While applauding the progress, CMS noted it reserves the right to pursue further regulation if necessary.

With commitments from industry giants and strong federal leadership, prior authorization reform now appears to be moving from policy vision to practical implementation—offering hope for millions of Americans seeking faster, fairer access to care.

DailyClout.IO will continue following this story. Source article posted here.

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