The nation’s top Medicare Advantage and Medicaid managed care programs have announced a series of reforms to improve the prior authorization process.
 
The move was announced June 23, 2025, by America’s Health Insurance Plans (AHIP), the insurance industry’s national trade association.
 
Participating health insurers have pledged to:
  • Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources (FHIR)-based application programming interfaces.
  • Reduce the volume of medical services subject to prior authorization by Jan. 1, 2026.
  • Honor existing authorizations during insurance transitions to ensure continuity of care.
  • Enhance transparency and communication around authorization decisions and appeals.
  • Expand real-time responses to minimize delays in care with real-time approvals for most requests by 2027.
  • Ensure medical professionals review all clinical denials.
Several of these moves have been long-sought by home health providers who have struggled with prior authorizations, often resulting in delays in care for patients or providers going unpaid for some services.
 
“If these promises are fully kept, this could be a meaningful step toward addressing longstanding barriers that have delayed access to critical care at home for patients who need it,” said Dr. Steve Landers, CEO of the National Alliance for Care at Home (the Alliance) in a statement.
 
CMS Administrator Dr. Mehmet Oz said the agency will be evaluating progress and driving accountability on the promised reforms.
 
“These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” Oz said in a statement.