CMS urged to rigorously enforce new policies to safeguard MA coverage

AHA urged the Centers for Medicare & Medicaid Services to rigorously enforce changes that were included in the calendar year 2024 Medicare Advantage final rule to improve how coverage works for enrollees, promote more timely access to care, ensure better alignment and coverage parity between Traditional Medicare and Medicare Advantage, and reduce the administrative burden of health plan requirements on health care providers and their patients.  
  
“While we recognize the new rules do not apply to coverage years before Jan. 1, 2024, we are concerned by reports from our members that certain [Medicare Advantage organizations] may not comply with the new regulations,” AHA wrote. “Specifically, as a result of interactions with MAO partners, hospital leaders have heard from some MAOs that they either do not plan to make any changes to their protocols as a result of the new rules or, in contrast, have made changes to their denial letter terminology or procedures in a way that appears to circumvent the intent of the new rules.”  
  
AHA urged the agency to conduct rigorous oversight to enforce the policies and safeguards included in the rule and to ensure that appropriate action is taken in response to any violations.