From policy changes announced by UnitedHealthcare, to a final rule issued by CMS, here are seven key prior authorization updates Becker's has reported so far in 2023.
1. More than 230 U.S. representatives and 61 senators sent letters to HHS and CMS leaders urging them to bolster a proposed rule aimed at streamlining the prior authorization process.
2. UnitedHealthcare backed off a controversial gastroenterology endoscopy prior authorization policy and instead set up an advance notification process for non-screening GI procedures.
3. Nearly 90 prior authorization reform bills have been introduced in 30 state legislatures so far this year, according to the American Medical Association.
4. Google Cloud launched a new artificial intelligence-powered claims acceleration suite designed to accelerate the prior authorization process.
5. CMS issued a final rule that, among other things, aims to streamline Medicare Advantage and Part D prior authorizations and clamp down on misleading marketing practices.
6. UnitedHealthcare is moving forward with a plan to eliminate 20 percent of its current prior authorizations and implement a national gold-card program. Code reductions will begin this summer and continue through the rest of the year for most commercial, Medicare Advantage and Medicaid plans.
7. Texas' physician gold-card rule took effect in October, but providers are not seeing the results they hoped for, according to the American Hospital Association.