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MEDICARE ADVANTAGE IN THE HEADLINES: 7 RECENT UPDATES
Rylee Wilson - Updated Thursday, December 22nd, 2022
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As the year draws to a close, lawmakers and advocates are discussing ways to
improve Medicare Advantage in the future and tackling issues around prior
authorization and marketing.
Here are seven Medicare Advantage updates Becker's has reported since Dec. 9:
1. Sachin Jain, MD, president and CEO of SCAN Group, sat down with Becker's to
discuss the company's recently announced combination with CareOregon, along
with current and future trends in Medicare Advantage.
2. Better Medicare Alliance, a pro-Medicare Advantage advocacy group, wants
more frequent audits and more robust criteria for in-home health risk
assessments for beneficiaries. The group issued a set of recommendations to
improve the public-private partnership for 2024 and beyond.
3. CMS issued a proposed rule to continue its efforts to overhaul prior
authorization and marketing practices around Medicare Advantage and Part D
plans, along with adding health equity measures to star ratings and boosting
behavioral health network adequacy requirements.The proposed rule would also
implement a key prescription drug affordability provision of the Inflation
Reduction Act.
4. Some Medicare Advantage plans that face auditing are granted hardship
requests to exclude certain patient records, according to an investigation
from Kaiser Health News. CMS said it approves around 20 percent of the
hardship requests it receives.
5. A group of Democratic senators and representatives are concerned about
healthcare organizations with previous allegations of fraud and abuse,
including multiple payers, participating in the ACO REACH program.
6. Knowing where Medicare Advantage dollars are being spent is a top priority
for CMS, Administrator Chiquita Brooks-LaSure said at the Milken Future of
Health Summit. Ms. Brooks-LaSure said determining how supplemental Medicare
Advantage benefits are being used is another top focus for the agency.
7. Sponsors of the Improving Seniors' Timely Access to Care Act, designed to
reform the Medicare Advantage prior authorization process, said the
legislation is "one step closer to becoming law" after CMS released a
proposed prior authorization improvement rule Dec. 6. The bill would
establish an electronic prior authorization process and require Medicare
Advantage plans to report to CMS the extent of their use of prior
authorization and the rate of approvals or denials.
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Do not miss our latest webinar: Reimagining your RCM strategy in 2023 with
intelligent automation which will take place on Wednesday, January 11th, 2023 at
12:00 PM CST - Register Now
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