United Health Care Announces Plan to Reduce Prior Authorizations by 20%
On March 30, 2023, United Health Care (UHC) announced a plan to reduce prior authorization requirements for (yet undefined) services as well as adoption of Gold Card programs. Their announcement indicated they intend to reduce nearly 20% of prior authorizations required beginning in July 2023. Of note, the health plan did not identify which procedures would be affected, nor did it specify whether their new policy would apply to retrospective review and denials after a procedure had been performed. These positive changes made by UHC are the result of multi-year sustained efforts made by the clinical community and groups like ISASS that have prioritized reducing the burden of prior authorization on physicians and practices.
UHC also announced that starting in early 2024, they will implement a national Gold Card program for care providers meeting eligibility requirements, eliminating prior authorization requirements “for most procedures.” This would apply to commercial, Medicare Advantage, and managed Medicaid programs. Services must still be deemed a covered benefit by the health plan with care providers qualifying for this program. In Texas, Gold Card qualification occurs when, during a prior 6-month period, a physician was approved for at least 90% of prior authorizations for a particular service; such a physician will not be subject to prior authorizations for that service for the next 6 months. West Virginia implemented a similar program. New York, Colorado, Indiana, Kentucky, Mississippi, Tennessee, and Virginia are pursuing similar legislation. The U.S. Congress is also advancing its own Federal legislation to reduce the burden of prior authorization (e.g., HR 7995).
ISASS is pleased with this announcement and will work with UHC to ensure the implementation of the plan achieves its stated goals for our members. We will also continue to advocate for states, the U.S. Congress, and private payers to pursue administrative relief for physician practices.
To read the proposed congressional bill, see here.