On Wednesday, the Centers for Medicare & Medicaid Services (CMS) Administrator, Dr. Mehmet Oz, announced a broader push to coordinate payers, providers, technology vendors and developers around shared standards for electronic prior authorization. He set a Jan. 1, 2027, deadline for certain CMS-regulated payers to implement electronic prior authorization interfaces.
“When a health care provider orders a test, procedure or medication, the paper-based prior authorization process can drag on for days or even weeks,” Oz wrote. “It is way past time to axe the fax, kill the clipboard and put patients over paperwork.”
While home-based care stakeholders generally shared supportive responses regarding the push to digitize prior authorization, with some electronic health record (EHR) providers especially positive, LeadingAge, the association of nonprofit providers of aging services, cautioned that this is “not a clear home run for providers.”
“Providers are not required to use these tools, and it is not clear from CMS communications – including this blog from Administrator Oz – whether post-acute care providers, including home health agencies, will be able to take advantage of these electronic submissions and, in doing so, reap the desired result of reduced administrative burden,” Nicole Fallon, vice president of managed care and integrated services at LeadingAge, told Home Health Care News in an email.
CMS has previously required payers across Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP) and Marketplace (Federally-facilitated Exchange) plans to send prior authorization decisions within 72 hours for expedited requests and within seven calendar days for standard requests. Now, these payers will be required to have electronic prior authorization interfaces by the Jan. 1 deadline.
The electronic interfaces will eventually be incorporated into the Medicare Promoting Interoperability Program for hospitals and the Merit-based Incentive Payment System (MIPS) for clinicians, Oz wrote. He estimated that these prior authorization-focused efforts will save approximately $15 billion over 10 years.
Oz’s announcement comes 10 months after the U.S. Health and Human Services (HHS) sponsored a pledge by a group of about 50 health insurance plans, including UnitedHealthcare, SCAN Health Plan, Kaiser Permanente, and Humana, to reduce prior authorizations.
Prior authorizations impact home health
Delays tied to prior authorization are a frequent barrier to timely hospital discharges into home-based care settings.
Medicare Advantage plans often authorize one or two initial home health visits, Fallon said, which often allow only an assessment. Additional approval is then required for patients to receive services.
“This can often take 7-10 days, and during that waiting period, the individual needing home-based care goes without or must pay out of pocket for services,” Fallon said. “This disrupts continuity of care and leads to unnecessary care delays, which could have detrimental impacts on an individual’s recovery trajectory.”
That timeline is at odds with the reality that many home health patients require care within 24 to 48 hours after discharge, according to Michelle Barlow, director of clinical and regulatory excellence at Homecare Homebase.
“HCHB data show that the average time from home health referral to start of care increased 28% between 2022 and 2025,” Barlow told HHCN in an email. “That trend should concern anyone focused on access, affordability and site-of-care optimization.”
Technology partners’ reactions
For Barlow, the Jan. 1 deadline gives payers, providers and their technology partners a clear point of accountability. When executed well, electronic prior authorization can reduce burden and improve access. When executed poorly, “it will simply move today’s friction into a new digital channel,” she said.
“HCHB supports API-based connectivity and automation that can help providers identify requirements, assemble documentation, track authorizations and reduce manual work, but decisions that affect access to covered home-based care should include transparency, clear accountability, clinician oversight and meaningful review,” Barlow continued.
For Andrew Olowu, chief technology officer at Axxess, CMS’ electronic prior authorization push is making it possible for the home-based care industry to finally “axe the fax.”
“This is a meaningful step forward for the industry and a strong signal of where healthcare is heading,” Olowu told HHCN in an email. “What stands out most is that this is really about transforming the operational foundation of healthcare through interoperability, embedded workflows and connected data exchange. Axxess views this as an opportunity to move beyond documentation systems and become true operational platforms that connect providers, payers, patients, and care teams in real time.”
Organizations that combine interoperability, AI, workflow intelligence and thoughtful change management will be successful in the future, he continued.
For Tim Ashe, chief clinical officer at WellSky, CMS’ push for electronic prior authorization is a “powerful signal” marking the future direction of health care innovation.
“For the home-based care industry, the Jan. 1, 2027 deadline will drive significant modernization around interoperability, workflow automation, and real-time data exchange,” Ashe told HHCN. “At WellSky, we see this as a pivotal moment.”
If hospitals are more directly involved with the prior authorization process, some of the administrative burden historically placed on post-acute care providers can be alleviated, Ashe continued.