New UHC MA Prior Auth Policy Improves Seniors Early Access to Care but Doesn’t Go Far Enough
Submitted on Mon, 01/13/2025 - 09:48
If you contract with UHC/Optum you may have received an update notice regarding the prior authorization requirements. APTA, the Academy of Orthopaedic Physical Therapy, and APTA Private Practice are encouraged but not satisfied with United Healthcare’s revision of Medicare Advantage prior authorization requirements to allow for an initial 6 visits without conducting a clinical review. While this is a step toward ensuring early access to services are not disrupted it did not go far enough in removing the burdensome prior authorization process or guaranteeing Seniors get all the care they were promised under the Medicare program.
This progress would not have been possible without APTA’s Payment Consortium, our collaboration between APTA’s payment and advocacy teams, AOPT, and PPS, as well as APTA members who provided us with the proof of how this was adversely impacting the people we serve. We are proud of this “better together” moment but know we have plenty of work left to do.
We are committed to ensuring that the value physical therapy provides to the health of society is better recognized and paid across the health care system. Our payment and advocacy teams are committed to working alongside you to ensure that every person in every community has access to the physical therapy they need.
For any practices who still choose to contract with UHC/Optum, we will be following the implementation of this new policy to ensure approval for clinically justified care that extends beyond 6 visits/8 weeks is not denied. or made more administratively burdensome. Please stay tuned in and in touch as we monitor the implementation of this new policy and continue to advocate to remove all barriers to the care you provide.
Links to the notices can be found here: