Prior authorization in 2022: 13 updates

Healthcare providers have been pushing for prior authorization reform this year, and many states are passing legislation to remove prior authorization requirements. 

Here are 13 updates on reforms this year:

1. CMS removed a type of corrective eyelid surgery from the hospital outpatient department prior authorization list Jan. 7. 
2. UnitedHealthcare now requires members to obtain prior authorization before undergoing physical and occupational therapy at multidisciplinary offices and outpatient hospitals in four states.
3. Thirty-four percent of physicians reported that delays in processing a prior authorization led to a serious adverse event for a patient in their care, according to a February survey from the American Medical Association. 
4. UnitedHealth Group has decided to stop mailing prior authorization and clinical decisions to providers on paper.
5. Seventy-nine percent of medical groups say that payer prior authorization requirements increased in the last year, according to a March poll conducted by Medical Group Management Association.
6. Thirteen percent of denied prior authorization requests made by Medicare Advantage organizations met Medicare coverage rules, according to a review conducted by the HHS Office of Inspector General released in April. 
7. Aetna will no longer require prior authorization for cataract surgery and video electroencephalography procedures. 
8. California's Health Care Services Department issued a notice that removed prior authorization requirements for most drugs Under Medi-Cal, the state's Medicaid program. 
9. Michigan Gov. Gretchen Whitmer signed legislation that reforms the prior authorization process in Michigan. The Health Can't Wait Act shortens the time payers have to consider prior authorization requests before they are considered granted and requires payers to provide more information to the public and providers regarding the prior authorization process
10. UnitedHealthcare plans will only pay for the controversial Alzheimer's drug Aduhelm for patients in clinical trials who have received prior authorization. 
11. Blue Cross Blue Shield of Wyoming and Eden Prairie, Minn.-based Itiliti Health partnered to create a cloud-based automatic prior authorization system for providers.
12. The Ohio Hospital Association is partnering with Columbus, Ohio-based Rhyme to improve efficiencies within prior authorization at hospitals and health systems across the state.
13. A California Senate bill aims to cut prior authorization red tape by allowing physicians to spend less time on paperwork and billing.