AHA Statement on CMS Medicare Advantage Proposed Rule

Ashley Thompson
Senior Vice President, Public Policy Analysis and Development
American Hospital Association

November 26, 2024

The AHA commends CMS for taking important steps to increase oversight of 2026 Medicare Advantage plans to help ensure enrollees have equal access to medically necessary health care services. The AHA has previously raised concerns about the negative effects of certain Medicare Advantage practices and policies that have the potential to directly harm patients through unnecessary care delays or outright denial of covered services.

We appreciate that CMS’ proposed rule builds upon prior rulemaking to strengthen limitations on commercial insurer use of internal or proprietary coverage criteria that are more restrictive than Traditional Medicare and can compromise enrollee access to Medicare-covered services. We also are pleased that it would increase oversight of prior authorization and utilization management tools, apply important guardrails on insurer use of artificial intelligence, and update medical loss ratio reporting requirements to ensure appropriate oversight of vertically integrated insurers. As enrollment in Medicare Advantage has for the first time reached more than half of all people enrolled in Medicare, it is more important than ever to establish and implement stronger consumer and beneficiary protections and curtail practices that can impede patient access to care.

The AHA will continue to carefully review the proposed rule and support efforts to improve the Medicare Advantage program for patients and their providers. 

###