6 prior authorization updates

From UnitedHealthcare releasing details about its national gold-card program to a reform bill in California clearing one of its final legislative hurdles, here are six updates on prior authorization that Becker’s has reported since Aug. 20: 

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1. The Biden administration finalized new requirements for health plans to strengthen mental health parity laws for 175 million Americans. The new rule, introduced in July 2023, will require plans to analyze the outcomes of their mental health coverage policies, including network size, out-of-network payment policies and prior authorization requirements. The new rule clarifies that plans cannot have more restrictive prior authorization standards or narrower networks for mental health services. 

 2. Prior authorization ranks among the top challenges for revenue cycle departments and physicians, according to recent reports. 

 3. UnitedHealthcare released details on its national gold-card program that is set to take effect on Oct. 1.

 4. Ten states have passed laws reforming the prior authorization process in 2024, according to the American Medical Association. 

 5. Carson City, Nev.-based Carson Tahoe Health will no longer be in network with UnitedHealthcare’s commercial and Medicare Advantage plans after May 30, 2025, citing challenges around processing claims and prior authorization requests. 

 6. A California bill aiming to reform prior authorization cleared one of the final hurdles for bills making their way to the governor’s desk.

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