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AHA Urges MedPAC to Examine Medicare Advantage Denials, Hospital Market Basket
We appreciate the Medicare Payment Advisory Commission’s (MedPAC) November meeting discussions on Medicare Advantage (MA) prior authorization and network management. As MedPAC begins its discussions on payment adequacy for the Medicare program, we outline concerns about the impact that the shifting labor force and costs have had on hospitals and health systems, including whether the current market basket methodology is adequate to capture these changes.
Senators call for CMS to increase MA plan oversight, reporting requirements
The Centers for Medicare & Medicaid Services should require Medicare Advantage plans to submit additional data and the agency should publicly release the MA data it already collects, a bipartisan group of senators told the agency last week.
CMS warns MA, Part D plans and PBMs to comply with new access requirements
The Centers for Medicare & Medicaid Services will closely monitor Medicare Advantage and Part D plans for compliance with new requirements effective Jan. 1 to ensure timely access to care, medications and vaccinations, the agency warned plans and pharmacy benefit managers Dec. 14.
AHA Comments on CMS’ Proposed Medicare Advantage Policies for 2025
AHA comments on the CMS proposed rule for policy and technical changes to the Medicare Advantage program in contract year 2025.
AHA comments on proposed Medicare Advantage policies for 2025
AHA Jan. 5 voiced strong support for Centers for Medicare & Medicaid Services proposals to increase oversight and enhance consumer protections in the Medicare Advantage program for contract year 2025.
UnitedHealthcare clarifies new hospital services review process for Medicare Advantage plans
UnitedHealthcare has released a FAQ to clarify its hospital services review process for Medicare Advantage products effective Jan. 1, 2024 under the calendar year 2024 Medicare Advantage final rule.
Protecting Patient Care with Enhanced Medicare Advantage Oversight and Prior Authorization Changes
For many people, choosing an MA plan is a life-changing event and a significant act of trust, counting on the payer they selected to provide the pre-agreed upon coverage for either current medical needs or those that may arise.
Committee probes Medicare Advantage marketing tactics
Senate Finance Committee Chairman Ron Wyden, D-Ore., Jan. 23 asked five third-party marketing organizations that participate in Medicare Advantage enrollment to provide certain information by Jan. 31 about their business practices as the committee continues its inquiry into problematic MA marketing practices.
CMS seeks input to strengthen Medicare Advantage data, transparency
The Centers for Medicare & Medicaid Services seeks input through May 29 on ways to strengthen Medicare Advantage data to guide policymaking and advance transparency.
AHA proposes how Congress could truly reduce national health expenditures
In a statement submitted to the House Energy and Commerce Subcommittee on Health for a hearing Jan. 31 on national health expenditures, AHA urged the subcommittee to prevent certain Medicare Advantage plans from engaging in tactics that restrict and delay access to care while adding burden and cost to the health care system.