AHA today encouraged the Centers for Medicare & Medicaid Services to work with Congress to require Medicare Advantage plans to waive prior authorization and other utilization management policies during public health emergencies, especially for hospitals transferring patients to post-acute care. 

While many plans worked with providers to waive or relax onerous prior authorization requirements during the COVID-19 emergency, others did not or only did so during the initial stages, exacerbating capacity issues, delaying patient care and resulting in inappropriate denials, AHA wrote, responding to a request for information on the issue included in CMS’ proposed rule for the MA program in 2023.

The AHA letter also points to issues and concerns regarding access to appropriate behavioral health specialties in MA, and recommends that CMS collect and publicly display data on the adequacy of MA behavioral health coverage. Finally, the letter offers general support for additional health plan oversight provisions included in the proposed rule.
 

Related News Articles

Headline
The AHA July 2 expressed support for the Resident Physician Shortage Reduction Act (H.R. 3890), bipartisan legislation that would add 14,000 Medicare-funded…
Headline
The House July 3 voted 218-214 to pass the final version of the One Big Beautiful Bill Act (H.R. 1), which enacts many of President Trump’s legislative…
Headline
The AHA July 3 released the Health Care Plan Accountability Update for the second quarter of 2025. The update covers the latest developments in Medicare…
Headline
The Departments of Justice and Health and Human Services today announced the creation of the DOJ-HHS False Claims Act Working Group to combat health care fraud…
Headline
The Senate narrowly passed the One Big Beautiful Bill Act (H.R. 1) on July 1 by a 50-50 tally, with Vice President J.D. Vance casting the tie-breaking vote.…
Headline
The AHA June 29 sent a letter to senators urging them to amend the budget reconciliation bill before its final passage in the Senate. The Senate version of the…