Prior Authorization Reform Is Long Overdue, Especially for Remote Care

The Reality We’re Seeing on the Ground

While the percentage of patients needing PA is low for RPM/CCM, those patients are most impacted, especially in specific state Medicaid plans.

As our Director of Customer Success recently shared:

“RPM and CCM are the most impacted. We’re seeing 7–10 day delays to enroll patients—sometimes even longer depending on the plan.”

In some cases, we’ve had to pause or slow down onboarding because plans misunderstood the nature of the services. For example:

• A practice association initially categorized RPM as an “emergency service,” requiring internal review before enrollment could proceed. This caused one-week delays for some patients.
• With one partner, the PA process took a full week. During that time, we often had to resend documentation, further delaying enrollment—a pattern we’ve seen with other facilities as well.
• At another partner organization, the burden has fallen on clinic staff, who’ve had to assign extra resources to manage prior authorization submissions.

When Care Is Delayed, Everyone Loses

Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Remote Therapeutic Monitoring (RTM) offer essential, timely support, especially for patients managing chronic illness or recovering from acute conditions. But prior authorization delays can:

• Postpones care for patients who already qualify
• Increases workload for already-stretched clinic staff
• Erodes trust and engagement for both patients and clinicians

“It slows adoption and frustrates everyone involved,” our team adds. “We know these services help people. But we lose valuable time when we’re forced to resubmit forms or wait days for review.”

The Pledge Is Encouraging

We hope this renewed spotlight on PA reform leads to real, lasting change. The proposed shift toward electronic authorization and a narrower set of required services could make a meaningful difference.

But it’s important to acknowledge that this pledge, while encouraging, is voluntary, and similar commitments made in the past have not always resulted in actual change. The delays are not theoretical for clinics, patients, and care coordinators. They’re a daily reality.

What Needs to Happen Next

We support:

• Greater transparency about which services require PA, and why
• Transparent, standardized processes across payers
• Enforceable accountability for turnaround times
• Patient-centered workflows that prioritize access, not paperwork

We also encourage providers to continue documenting delays and sharing feedback so that these stories can inform the national conversation.

Why It Matters for the Future of Care

RPM, CCM, and RTM are essential to delivering proactive, preventive care, especially in rural, low-access, and safety net settings. We have the tools, the technology, and the clinical readiness; now we need the systems to catch up.

When prior authorizations delay services, they stall data collection or patient engagement and postpone interventions that could prevent hospitalizations or serious complications.

Closing Thoughts

Prior authorization should be a checkpoint, not a roadblock. At KangarooHealth, we’re committed to bringing visibility to the challenges clinics and care teams face, while standing alongside them as a partner in the process.

We recognize that delays in prior authorization can pause the start of services, but they shouldn’t discourage clinics from pursuing remote care. The value of RPM, CCM, and RTM is well established, and preparing to launch means your organization is ready the moment approvals are in place.

We’re here to support that readiness. From program setup to care team coordination, we work hand in hand with our partners to ensure that, once authorization is secured, patients receive the timely, focused support they deserve.

Because no one should have to wait longer than necessary for care they’re already eligible to receive.

Learn more about how we enable quick implementation and patient enrollment.