AHA urges HHS OIG to further scrutinize Medicare Advantage organizations' use of prior authorization for post-acute care

The AHA Sept. 17 urged the Department of Health and Human Services’ Office of Inspector General to further scrutinize policies and practices by certain Medicare Advantage Organizations (MAOs) that impede patient access to post-acute care and circumvent rules designed to ensure access and coverage parity between MA and Traditional Medicare. HHS OIG in June initially announced it would examine MAOs' prior authorization denials for post-acute care after a qualifying hospital stay.  

"Hospitals and health systems continue to experience inappropriate denials and delays in care for MA beneficiaries consistent with the concerns raised by prior HHS OIG work that found MAOs sometimes denied prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules," AHA wrote. "As indicated by the mounting evidence of inappropriate insurer denials and delays of post-acute care services, further scrutiny of these practices is warranted. The AHA strongly supports investigation into and greater oversight of MAO practices, particularly as they pertain to access to post-acute care services."