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.

Related News Articles

Headline
The AHA Sept. 29 sent recommendations to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure…
Headline
The Centers for Medicare & Medicaid Services announced Sept. 26 that average premiums for Medicare Advantage and Part D would decline slightly in 2026.…
Headline
The AHA expressed support Sept. 22 to House and Senate sponsors of the Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), legislation that would apply a…
Headline
The Centers for Medicare & Medicaid Services Sept. 18 released a final rule on policy and technical changes to Medicare Advantage, the Medicare…
Headline
The AHA Sept. 15 expressed support for the Ensuring Access to Essential Providers Act, legislation that would require Medicare Advantage plans to cover…
Headline
The AHA Sept. 15 urged Aetna to rescind its recently announced “level of severity inpatient payment” policy, saying that it “could erode the transparency…