卫生部与劳工部：五家大雇主支持电子预授权扩展 自保医保逾1.8亿人有望少等审批
华盛顿——美国卫生与公众服务部（HHS）10月21日宣布，该部下属的联邦医疗保险和医疗补助服务中心（CMS）与美国劳工部（DOL）当天共同宣布，Amazon、Axon Enterprise、Google、Meta 与 Oracle 五家大型雇主已签署支持声明，支持把电子预授权的技术改进与相关能力，扩展到雇主自保（self-funded）健康计划。
所谓预授权，是医保计划在承保某些医疗服务前先行审批的环节。HHS 表示，目前碎片化的预授权流程迫使医疗机构按患者所持保险的不同类型走不同流程，传真、电话与纸质材料仍很常见；扩大电子预授权的应用可减少人工环节、改善信息交换，让患者与家庭少受行政延误。
HHS 援引美国人口普查数据称，超过53%的美国人、逾1.8亿人通过雇主自保计划获得医保。这类计划通常由雇主委托第三方管理机构等服务商运营，预授权也多由这些服务商处理；劳工部下属的雇员福利保障局（EBSA）直接对接雇主福利领域，包括自保计划。
卫生部长 Robert F. Kennedy Jr. 表示，预授权应当帮助患者得到恰当的治疗，而不是把医生和家庭困在行政延误里，HHS 正在削减不必要的繁文缛节、现代化医保计划的承保决定方式。CMS 负责人 Dr. Mehmet Oz 表示，患者和医生不该仅仅因为医保的出资方式不同，就退回到传真和纸面流程。劳工部雇员福利保障局助理部长 Daniel Aronowitz 表示，签署这份支持声明，显示政府与私营部门正共同为美国劳动者减少繁琐手续。
HHS 介绍，这次雇主承诺建立在2025年6月 CMS 取得主要健康计划自愿承诺的基础上——当时各计划承诺标准化电子预授权、减少需预授权的服务数量、提高透明度并增加实时回复。此外，CMS 的互操作与预授权最终规则要求部分受影响的付款方自2027年1月1日起，为医疗物品与服务落实电子预授权能力。
HHS 表示，预授权改革需要医疗体系各方的参与与问责；把自保计划雇主的声音纳入后，CMS 与劳工部希望在更广泛的商业保险市场中推动对电子预授权能力的需求。有意支持的雇主可通过 CMS 公布的邮箱 [email protected] 联系。
HHS and Labor: Five Major Employers Back Expanding Electronic Prior Authorization to Self-Funded Plans Covering 180 Million People
WASHINGTON — The U.S. Department of Health and Human Services (HHS) announced on October 21 that its Centers for Medicare & Medicaid Services (CMS), together with the U.S. Department of Labor (DOL), said five major employers — Amazon, Axon Enterprise, Google, Meta and Oracle — have signed a statement of support for extending the technical improvements and capabilities developed through the 2025 Prior Authorization Pledge to employer-sponsored self-funded health plans.
Prior authorization is the review health plans conduct before covering certain care. HHS said a fragmented system forces providers to navigate different workflows depending on a patient's coverage, with faxes, phone calls and paperwork still common; broader use of electronic prior authorization can reduce manual processes, improve information exchange and cut administrative delays for patients and families.
Citing U.S. Census data, HHS said more than 53 percent of Americans — more than 180 million people — receive coverage through employer-sponsored self-funded plans. Such employers often rely on third-party administrators and other service providers to run health benefits, including prior authorization, and the Labor Department's Employee Benefits Security Administration (EBSA) works directly with the employer-sponsored benefits community, including self-funded plans.
HHS Secretary Robert F. Kennedy Jr. said prior authorization should help patients get the right care rather than trap doctors and families in administrative delays, and that HHS is cutting bureaucracy and modernizing how health plans make coverage decisions. CMS Administrator Dr. Mehmet Oz said patients and doctors should not have to fall back on faxes and paperwork simply because of how a plan is funded. Assistant Secretary for the Employee Benefits Security Administration Daniel Aronowitz said the signing shows government and private industry working together to help employees cut through red tape.
HHS said the employer commitment builds on voluntary commitments CMS secured from major health plans in June 2025 to standardize electronic prior authorization, reduce the volume of services subject to it, improve transparency and increase real-time responses. CMS's Interoperability and Prior Authorization Final Rule also requires certain payers to implement electronic prior authorization capabilities for medical items and services beginning January 1, 2027.
HHS said meaningful reform requires participation across the health system, and that adding employers that sponsor self-funded plans helps build demand for electronic prior authorization across more of the commercial insurance market. Employers interested in supporting the effort can contact CMS at [email protected].
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图片来源：图：位于华盛顿的美国卫生与公众服务部（HHS）总部 Hubert H. Humphrey Building（2026年3月摄）。照片：APK，CC BY 4.0，经 Wikimedia Commons。 / The Hubert H. Humphrey Building, headquarters of the U.S. Department of Health and Human Services in Washington, D.C. (March 2026). Photo: APK, CC BY 4.0, via Wikimedia Commons.
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