AHA urges changes to MA prior authorization requirements for public health emergencies

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.