AHA makes recommendations supporting CMS’ proposed MAO data collection and audit protocol

The AHA Nov. 11 voiced strong support for the Centers for Medicare & Medicaid Services’ proposed plan for data collection and reporting requirements for Medicare Advantage organizations. In addition, the AHA supports CMS’ proposed audit protocol, which would assess MAO compliance with MA utilization management program requirements codified in the calendar year 2024 MA final rule.  

The AHA provided detailed comments on the scope and mechanisms for required reporting and identified opportunities to increase public transparency of MAO performance. In addition, the AHA provided specific recommendations to strengthen requirements and reporting related to MAOs’ use of internal coverage criteria, compliance with the two-midnight benchmark and access to post-acute care — where hospitals and health systems report the greatest challenges and concerns with MA practices diverging from Medicare rules and requirements. AHA also identified other priority areas warranting increased oversight, including MAO requests for additional documentation, peer-to-peer requests, member appeals and business practices of third-party vendors.