The Centers for Medicare and Medicaid Services (CMS) is exploring proposals that would reduce the number of procedures requiring prior authorizations (PA), according to recent reports by Bloomberg and other media outlets. Ideas lacked specificity but fall into the broad categories of creating more uniformity across plans, automating coverage determinations to speed up decisions, and streamlining these processes with an eye to reducing provider burden.

LeadingAge has long advocated to CMS for a more uniform, streamlined approach to PAs with the goal of reducing providers’  administrative burden; we also support the Improving Seniors Timely Access to Care Act, which has similar goals.

These CMS discussions, while nascent, respond to public outrage on the delays and denials of care following the murder of United Healthcare CEO in December 2024.

Whether CMS intends to reduce prior authorizations across all types of services or is mainly focused on physicians and hospital settings is unknown. The October 2024 Senate report, “Refusal of Recovery”, demonstrated that skilled nursing facility services are being denied at significantly higher rates than all other services requiring prior authorization. Therefore, we would hope that this information is informing CMS’s work to reduce and improve these processes.

It remains to be seen if CMS will pursue these proposals through new or revised regulation, or if it would ask for plans to voluntarily comply with new standards.

CMS Administrator Dr. Mehmet Oz in his confirmation testimony demonstrated an interest in using artificial intelligence (AI) to speed up processes like PA.

We will engage CMS on this, as we have concerns regarding how some plans are using AI already to make quick but erroneous decisions denying medically necessary services.

In addition, our Post Acute Care Medicare Advantage Coalition has reaffirmed that further improvements to prior authorizations are a top advocacy priority for 2025. The coalition will be continuing its outreach to CMS on this topic.