AOTA advocacy: UHC Medicare Advantage prior authorization

In August 2024, United HealthCare (UHC) announced that it would implement prior authorization (PA) for outpatient therapy and chiropractic services for its Medicare Advantage plans. In response, AOTA and a coalition of industry partners began advocating for clinicians and providers, expressing our concern about the potential impact on UHC’s Medicare Advantage enrollees as well as the added administrative burden on outpatient clinics and facilities. The coalition requested the removal of the program, or at the very least, that its implementation be delayed, allowing more time for clinicians and providers to prepare for the changes, allowing to modify the program, but agreed to meet.

Once the program began on September 1, 2024, clinicians and providers began reporting challenges with the program, including an inability to connect to the system, delays in response times, denials, and partial approvals that were insufficient to meet clients' needs.

AOTA, APTA, and ASHA met with UHC Medicare Advantage leadership in early November to discuss these issues. However, UHC indicated that although the initial rollout was not as efficient as they would have liked, their data showed improvement. According to UHC, over 60% of prior authorization requests were fully approved, and another approximately 30% were partially approved.

However, reports from the field indicated that, while there was some improvement, concerns such as delays in response times and limited visit approvals persisted. Consequently, the broader therapy coalition met with the Centers for Medicare and Medicaid Services (CMS) staff in early November to express our concerns that UHC was not meeting the prior authorization requirements for Medicare Advantage plans as established by the 2024 Medicare Advantage final rule.

AOTA and our industry partners continue to gather data from our members and will continue to advocate for the issues into 2025. Members with questions or concerns about prior authorization under any health plan should contact AOTA’s Regulatory Affairs department at regulatory@aota.org.