HHS announces investigation of MA prior authorization use for post-acute care 

Jul 03, 2024 - 03:02 PM
A black nurse with a smile on her face shares a tablet with a white elderly patient lying in a hospital bed.

The Department of Health and Human Services’ Office of Inspector General last week announced its intent to investigate Medicare Advantage Organizations’ prior authorization denials for post-acute care after a qualifying hospital stay.  

“Medicare Advantage plans must cover at least the same services as original Medicare, but Medicare Advantage Organizations (MAOs) may impose additional administrative requirements, such as requiring prior authorization before certain services can be provided,” OIG said on its website. “We will examine selected MAOs' processes for reviewing prior authorization requests for post-acute care in long-term acute care hospitals, inpatient rehabilitation facilities and skilled nursing facilities. We will also review the extent to which the selected MAOs denied requests for post-acute care and examine the care settings to which patients were discharged from the hospital.” OIG expects to issue findings in 2026.

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