Why BCBS Massachusetts is cutting 14K prior authorization requirements

Blue Cross Blue Shield of Massachusetts' plan to remove 14,000 prior authorization requirements for home care services is a response to the capacity crisis in the state's hospitals, the payer's chief medical officer Sandhya Rao, MD, told NPR affiliate WBUR Nov. 8. 

Dr. Rao told the news outlet that with hospital beds in high demand, the company understands that every minute makes a difference and the change should allow patients to leave hospitals sooner and receive service at home. 

The requirements will be removed Jan. 1 for commercial members and in 2025 for Medicare Advantage members. 

Michael Sroczynski, senior vice president at the Massachusetts Health & Hospital Association, told WBUR the change is a promising step it hopes other payers will follow. 

"This is exactly the type of administrative simplification that can improve patients’ access to care, ease caregiver burnout, and reduce wasteful costs," Mr. Sroczynski said. 

In the Nov. 6 news release announcing the cuts, Dr. Rao defended prior authorizations, arguing that the process is "critically important as our state confronts the challenge of health care affordability for families and businesses."

"We have a responsibility to be good stewards of our members' premium dollars and to ensure that services and treatments contribute to improved health outcomes and lower costs for our members," she said. 

Ninety-eight percent of BCBS Massachusetts claims do not require prior authorization, the release stated. The payer also recently removed prior authorization requirements for other conditions including continuous glucose monitoring devices and supplies for Type 1 diabetes.

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