AHA Urges HHS and CMS to Enforce Prior Authorization Reforms

The American Hospital Association (AHA) has urged HHS Secretary Robert F. Kennedy Jr., CMS Administrator Mehmet Oz, MD, and insurance providers to advance prior authorization reforms. The AHA highlighted that 95% of hospitals report increased staff time spent on prior authorization approvals over the past year, leading to significant operational burdens and patient dissatisfaction. To address these challenges, the AHA recommends standardizing electronic prior authorization processes and limiting the scope of claims subject to prior authorization reviews.

The AHA also called on CMS to closely monitor insurance plans' adherence to these reforms, ensuring full compliance with recent regulations such as the Interoperability and Prior Authorization final rule and the 2024 Medicare Advantage final rule. Although CMS has committed to simplifying prior authorization, it announced the launch of an AI-driven prior authorization pilot for traditional Medicare in 2026, signaling ongoing efforts to enhance efficiency in the authorization process.