On June 23, 2025, Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, announced a significant agreement with major payers to reduce the volume and burden of prior authorizations (PA) across commercial, Medicare Advantage, Medicaid, and Marketplace plans.

Insurers, including United Healthcare, Aetna, Cigna, Humana, Blue Cross Blue Shield, and Kaiser Permanente, committed to a range of reforms. These include reducing the number of services requiring prior auth, implementing a standard electronic PA form by the end of 2026, making prior authorizations valid for 90 days even if a patient switches plans, and expanding the use of real-time electronic PA processes. Coverage of the announcement is available from Becker’s Payer Issues.

AHIP’s Aligned Announcement Offers Added Detail

The American Health Insurance Plans (AHIP) trade association echoed this momentum with a companion resource outlining six voluntary commitments affecting 257 million Americans. These include implementing FHIR-based electronic PA by January 1, 2027; reducing the number of services requiring PA by January 1, 2026; ensuring 90-day validity for approved PAs; improving the clarity of determinations; and committing to 80% of PA responses occurring in real-time by 2027.

Kim Keck, President and CEO, Blue Cross Blue Shield Association called this “a meaningful step forward in our work together to create a better system of health,” signaling broad alignment across payers, policymakers, and standards organizations.

This report mentions a commitment to regular reporting and transparency of the progress made.

Why This Matters—and How It Builds on CMS-0057

This announcement builds on the momentum already underway across the industry as organizations prepare to comply with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057). By aligning with the rule’s spirit, particularly the use of FHIR APIs to streamline and automate prior authorization, this new commitment from payers reinforces the direction the industry is already heading in by bringing in commercial lines of business.

At POCP, we consistently advise our clients that CMS-0057 should be viewed as a floor, not a ceiling. While compliance with the rule is critical, real transformation happens when organizations use the regulatory requirements as a springboard to redesign outdated workflows, improve the provider experience, and better support patient care. Today’s announcement supports that philosophy. It encourages organizations to not just meet the minimum standards, but to invest in scalable, future-ready solutions and embrace enterprise-wide transformation to improve patient experience.

The inclusion of aggressive real-time decision targets, simplified workflows, and greater transparency signals an encouraging shift: one where prior authorization modernization is no longer just a compliance exercise, but part of a broader movement toward smarter, more responsive healthcare infrastructure.

All that being said, organizations that haven’t made significant progress on their CMS-0057 compliance roadmaps need to accelerate progress immediately. Testing and leaving time to fail and iterate are imperative for success.

This Isn’t New—It’s Validation

This work didn’t begin today. The industry -- particularly Da Vinci members -- has been testing and refining FHIR-based approaches to PA for years. A great example is featured in this episode of The Dish on Health IT, where MultiCare Connected Care and Regence BlueShield share their experience piloting HL7 Da Vinci Project Implementation Guides.

Their pilot demonstrated that it’s not only possible to exchange clinical and administrative data in near real-time. It’s also critical to rethink workflows and educate staff to operate in this more automated, efficient environment.

POCP’s Take

POCP views today’s announcement as:

• A meaningful endorsement of prior authorization reform as a national priority that goes beyond Medicare and Medicaid plans to include commercial plans.
• A public affirmation that FHIR is central to enabling streamlined, patient-centered prior authorization
• Further validation that policy, standards, and implementation must move forward in coordination—not in silos

We’re encouraged to see the concepts and pilots the industry has been testing for years now reflected in formal payer commitments. That said, these commitments are voluntary and currently lack formal enforcement mechanisms or accountability measures. It remains to be seen whether industry and public pressure will be enough to drive consistent, measurable follow-through.

Still, the clear alignment with CMS-0057 and the emphasis on real-time, standards-based solutions signal growing momentum and a shared understanding that checking the compliance box alone won’t cut it. Sustainable progress will depend on action, transparency, and willingness to invest in meaningful change.

What Happens Next?

If you’re a stakeholder looking to learn more about the Da Vinci Implementation Guides or how to get started, visit the Da Vinci Project page or peruse implementer support resources.

If you’re a health plan, technology vendor, or provider organization wondering how today’s developments may impact your operations—or if you’re working through your CMS-0057 compliance strategy—POCP can help. We work with clients not just on technology implementation, but also on transforming business processes, educating staff, and implementing effective change management.

Let’s connect for a one-time, no-obligation conversation with one of our experts. We’d love to learn more about where you are and potentially offer a gut check on your CMS-0057 strategy.