The Trump administration is piloting a new Medicare plan that would require patients to receive approval before
undergoing medical procedures, which critics say will worsen health outcomes.
Medicare is the
government’s insurance program for seniors aged 65 and over and also covers younger people with disabilities.
Prior authorization is similar to how private insurers operate, often resulting in
a delay or denial of treatments. However, traditional Medicare plans typically require far less prior approval for procedures than private insurance. That allows older Americans to get surgeries and other procedures without having to jump through red tape before undergoing treatment.
The Centers for Medicare & Medicaid Services
said the pilot, which is set to begin in January across six states, would “crush fraud, waste, and abuse.”
Under the plans, the federal government would hire private companies to use artificial intelligence to evaluate whether patients would be covered for procedures such as skin and tissue substitutes, electrical nerve stimulator implants and knee arthroscopy for knee osteoarthritis.
The agency said that final decisions of the services that do not meet Medicare coverage “will be made by licensed clinicians, not machines.”
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