On May 19, 2022, the American Hospital Association (AHA) sent a letter to the Administrator of the Centers for Medicare and Medicaid Services (CMS) requesting CMS take “swift action to hold Medicare Advantage (MA) plans accountable for inappropriately and illegally restricting beneficiary access to medically necessary care” through improper and excessive denials of prior authorizations. AHA’s call for action is in response to the Department of Health and Human Services Office of Inspector General’s report on Medicare Advantage plans and prior authorizations. The report found that Medicare Advantage organizations denied 13 percent of prior authorization requests despite these requests meeting the coverage requirements. The AHA also supported HHS’s recommendation that CMS issue guidance on the appropriate use of medical necessity reviews and urged CMS to work with Congress to pass the Improving Seniors’ Timely Access to Care Act. HHS’ report on Medicaid Advantage and prior authorizations is available here. Additionally, AHA’s letter to CMS can be found here.
Last Updated on June 14, 2022 by Aimed Alliance
