Blue Cross Blue Shield of Massachusetts will end prior authorization requirements for home health care services for commercial members beginning in January 2024, and will end the practice for Medicare Advantage members in 2025.
The health care system announced the change Nov. 6. 2023, noting it will eliminate 14,000 authorizations, reduce administrative burden on clinicians and help hospitals expedite discharges to avoid overcrowding.
BCBS defended the use of prior authorization to “ensure that clinical decision making is consistent with clinical guidelines,” but noted that ending these prior authorizations for home health will simplify the discharge path to home with services that meet patient needs.