AOTA collaborates on framework to reform prior authorization
The American Occupational Therapy Association (AOTA) and its industry partners have released a new collaborative policy framework aimed at improving prior authorization and utilization review processes for occupational therapy and physical therapy services.
The framework reflects a shared commitment to patient-centered care, evidence-based decision-making, and reduced administrative burden. The guidance is aimed at payers, managed care organizations, and policymakers at the state and federal levels, encouraging alignment of administrative practices with clinical best practices and operational efficiency that remain focused on the patient.
Why prior authorization reform is needed
Prior authorization requirements are increasingly cited by practitioners as a major barrier to the timely provision of medically necessary therapy services. While intended to ensure appropriate care, it too often delays medically necessary therapy and is a pain point for patients and providers. Industry surveys consistently show that delays in authorization can interrupt care, worsen outcomes, and lead some patients to abandon treatment altogether. While payers and federal policyholders have launched initiatives to streamline prior authorization, AOTA believes these initiatives have not addressed the specific challenges experienced by occupational therapy practitioners. For therapy providers, the growing complexity and inconsistency of authorization systems divert time and resources away from direct patient care. For patients, delays of even a week or two can mean lost functional gains, prolonged recovery, or increased risk of complications.
“Prior authorization should never be a barrier to timely and medically necessary therapy services,” said AOTA CEO Katie Jordan, OTD, MBA, OTR/L, FAOTA. “This consensus framework puts patients first, reduces unnecessary administrative burden, and is essential to create a more equitable and efficient system. We urge its adoption by the payer community.”
A patient-centered framework
The jointly developed framework promotes a more transparent, equitable, and clinically sound approach to utilization management. It is grounded in four crosscutting principles:
- Transparency for beneficiaries
- Evidence-based standards
- Patient-driven care
- Standardized, provider-friendly systems
The framework also emphasizes accountability, including public reporting of authorization turnaround times, denial rates, and appeal outcomes.
Aligning policy with practice
This collaborative effort builds on longstanding advocacy by AOTA and others to reduce unnecessary administrative barriers that delay care and place undue strain on the therapy workforce. It also complements federal efforts to modernize prior authorization by enabling interoperability standards and faster decision timelines.
By aligning utilization management practices with clinical expertise and patient needs, the organizations aim to ensure that occupational therapy and physical therapy services remain accessible, timely, and effective.
In the future
AOTA encourages payers, regulators, and policymakers to adopt the principles outlined in the framework and work collaboratively with therapy professionals to modernize prior authorization processes. Reducing administrative burden while safeguarding appropriate utilization is not only good policy but also essential for supporting patients in their treatment plans and improving quality of life.
Questions regarding the framework can be sent to Regulatory@aota.org.