HHS Secretary Kennedy, CMS Administrator Oz Announce Insurers' Pledge to Fix Prior Authorization System

On June 23, HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz announced that several major health insurers have voluntarily pledged to streamline and improve prior authorization (PA) processes across Medicare Advantage, Medicaid Managed Care, Marketplace and commercial plans.

These reforms aim to cut administrative burden, reduce care delays and improve transparency for both patients and providers. The commitments include:

• Standardizing electronic prior authorizations using FHIR-based technology
• Reducing the number of services subject to PA by January 1, 2026
• Honoring existing authorizations during plan transitions
• Increasing transparency around decisions and appeals
• Expanding real-time decisions by 2027
• Requiring medical professionals to review all clinical denials

What This Means for RDNs

In our December 2024 Medicare Advantage survey RDNs reported being affected by PAs in various ways, including:

• Clinics facing burdensome PA requirements for anti-obesity medications (AOMs) and enteral nutrition products and supplies
• RDNs being tasked with PA paperwork due to staffing shortages, increasing administrative strain and impacting patient care
• Delays in care caused by unclear or complex PA policies

While the renewed focus on reducing barriers to care is encouraging, it's important to recognize that the commitments announced are voluntary. A similar pledge was made by some payers in 2018, but progress since then has been limited.

CMS has stated it will monitor outcomes, though formal accountability measures have not yet been announced. The Academy will continue to engage with CMS and coalition partners to ensure the voice of RDNs is included in efforts to modernize and improve administrative processes that impact nutrition care.

If you have recent examples of how prior authorization challenges have affected your ability to practice or your patient's ability to access care, we invite you to share them with us. Your insights help inform our advocacy.