Navigating the Future of Prior Authorization: A Path Forward with HTI-2

As we stand at the intersection of technology and healthcare policy, the conversation around prior authorization (PA) is more crucial than ever. For many healthcare professionals, PA remains an administrative burden that can delay necessary treatments for patients. The manual efforts—phone calls, navigating payer portals, and sending faxes—are all part of a time-consuming process that adds strain to both providers and patients.

The recent updates from the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) offer a glimmer of hope. The CMS Interoperability and Prior Authorization final rule, set to take effect in 2027, mandates that certain payers establish application programming interfaces (APIs) to automate the PA process. This move promises to reduce some of the administrative headaches associated with PA by streamlining approvals and improved transparency for both providers and patients into where the approval is in the process.

The ONC’s HTI-2 proposed rule, currently open for public comment, builds on this progress. By leveraging health information technology (IT) certification provisions, HTI-2 seeks to enhance the electronic PA process through certified health IT systems. This shift toward greater automation could help alleviate the manual tasks currently required and improve the overall patient experience.

However, while the intention behind these proposals is commendable, we must approach them with a sense of cautious optimism. There are still important questions about whether the technical standards and implementation guides proposed for adoption in HTI-2 have been adequately tested in real-world settings. Standards should be considered mature only after comprehensive real-world testing and public reporting of the use of those standards and lessons learned. Simply codifying these standards into regulation does not guarantee their effectiveness, suitability, or ensure wide-spread adoption by end-users in the long-term.

At AHIMA, we are committed to ensuring that the voices of those on the ground—those who will be implementing and using this technology—are heard. Our Health IT End Users Alliance will continue to advocate for practical, tested solutions that truly address the challenges faced by healthcare professionals and patients alike.

In summary, while the proposed rule offers promising steps toward improving PA processes, it is important that we carefully evaluate their real-world applicability. The journey toward streamlined and effective prior authorization is ongoing, and AHIMA remains dedicated to supporting policies that make a meaningful difference.

Let’s embrace these advancements with a focus on real-world impact and continue working together to enhance the healthcare experience for everyone involved.

Learn more about the HTI-2 Proposed Rule here.

Lauren Riplinger, JD, is chief public policy and impact officer for AHIMA.