As noted over the last few months, OSMA’s main advocacy priority this year is prior authorization reform. We’re supporting HB 130 in Ohio that creates a prior authorization gold card and we anticipate additional legislation in Ohio related to prior authorization and billing later this year. Additionally, we have commented on proposed rulemaking by CMS to reform prior authorization practices used by Medicare Advantage plans. This continued focus at the state and federal level is also starting to result in individual plans announcing revisions to prior authorization practices. The most recent being United Healthcare (UHC)—who recently made a statement regarding changes occurring this summer.
UHC is eliminating prior authorization requirements for codes that account for roughly 20% of its current PA volume, with reductions beginning in the third quarter of the year. The PA reduction process will comply with state and federal requirements, as well as existing commercial health plan contracts.
In early 2024, UHC also plans to implement a national “Gold Card Program” for eligible physician groups that will eliminate PA requirements for most procedures. Qualifying physician groups will be able to follow a notification process for most procedure codes, rather than a prior authorization process.
UHC is also using more automation to improve the PA experience and speed decisions, and it plans to introduce a new feature allowing patients to track their PA requests online at myuhc.com or through the company’s mobile app.