UnitedHealthcare said it’s going to eliminate most requirements for prior authorization for medical care for about 1,500 rural hospitals and their affiliated health care providers by this fall.
The change will affect all of the small, isolated rural hospitals classified as “critical access hospitals.”
In January, the United States had 1,381 critical access hospitals, according to the Rural Health Information Hub.
The UnitedHealth announcement affects about one-quarter of the United States’ has a total of about 6,100 registered hospitals.
UnitedHealthcare, a subsidiary of UnitedHealth Group, said it will also speed up payments to the rural hospitals and develop a new “hub-and-spoke” system to improve maternity care, diabetes care and other types of care in rural areas.
“This effort is designed to alleviate cost and staffing strains that disproportionately affect rural providers,” the company said.
What it means: Employers may find that employees in rural areas will have fewer complaints about getting access to hospital services.
UnitedHealth may get some relief from pressure from policymakers in Washington and from groups like the American Medical Association to ease prior authorization review efforts.
The backdrop: Health insurers have argued that prior authorization reviews can protect patients against unnecessary, overly expensive or even potentially harmful procedures and products.
But many states, including Virginia, have enacted laws restricting the views, and members of Congress have talked about the impact of the reviews on their own access to care as well as constituents’ access to care.
The Centers for Medicare & Medicaid Services, the arm of the U.S. Department of Health and Human Services that runs Medicare, Medicaid and HealthCare.gov, has been pressing health insurers to narrow the scope of their prior authorization programs.
Providers have expressed skepticism about whether insurers will make a serious effort to reduce prior authorization review volume.