CMS Strongly Encourages Medicare Advantage Plans to Relax Prior Authorization Requirements during Ongoing COVID-19 Surges

Special Bulletin

August 20, 2021

The Centers for Medicare & Medicaid Services (CMS) today issued a Health Plan Management System memo to all Medicare Advantage Organizations (MAO) and Medicare-Medicaid Plans to strongly encourage them to waive or relax plan prior authorization requirements and utilization management processes to facilitate the movement of patients from general acute-care hospitals to post-acute care and other clinically-appropriate settings, including skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies.

CMS in the memo highlights the recent surge of the COVID-19 delta variant and increased hospitalizations across the country and notes that “the ability of hospitals to transfer patients to appropriate levels of care without unnecessary delays or administrative burdens is critical to ensuring that hospitals have open acute-care beds to treat patients requiring emergent care.”

The AHA continues to work with both CMS and MAOs to encourage adoption of these waivers.

Further Questions

If you have questions, please contact AHA at 800-424-4301.

Related Resources

Letter/Comment
Public
AHA expresses concerned about some MA plans’ inappropriate restrictions on beneficiary access to medically necessary care, including those highlighted in a…
AHA Center for Health Innovation Market Scan
Humana recently said it plans to open about 100 new primary care clinics in a second joint venture with the private equity firm Welsh, Carson, Anderson…
Letter/Comment
Public
AHA urges CMS to take swift action to hold Medicare Advantage (MA) plans accountable for inappropriately and illegally restricting beneficiary access to…
Advancing Health Podcast
Public
Medicare Advantage or MA Plans are another way for beneficiaries to get Medicare Part A and Part B coverage delivered through private insurance companies.
Special Bulletin
Member
The Centers for Medicare…
Special Bulletin
Member
The AHA continues to push back forcefully against MA plan policies that restrict or delay patient access to care, and add cost and burden to the health care…