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AHA submits comments to House hearing on Medicare legislative proposals
AHA on Oct. 19 submitted a statement to the House Energy and Commerce Health Subcommittee on legislative proposals involving Medicare.
House letter on AI use in Medicare Advantage denials
Over 30 members of the House of Representatives Nov. 3 urged the Centers for Medicare & Medicaid Services to monitor and evaluate how Medicare Advantage plans use artificial intelligence and algorithms to guide their coverage decisions, and ensure these tools comply with Medicare rules and do not create barriers to care.
CMS releases proposed rule for 2025 Medicare Advantage, prescription drug plans
The Centers for Medicare & Medicaid Services Nov. 6 proposed changes to the Medicare Advantage and prescription drug programs for contract year 2025 intended to improve access to behavioral health care; ensure that agents and brokers enroll individuals in the best plan for their needs and that MA plans offer appropriate supplemental benefits; streamline enrollment for individuals dually eligible for Medicare and Medicaid; and annually review MA utilization management policies for health equity considerations.
Report: U.S. hospitals face diminished reserves, mounting reimbursement challenges
Payment denials by Medicare Advantage plans jumped 56% for the median health system between January 2022 and June 2023, contributing to a 28% decline in median cash reserves, according to the latest analysis of data from over 1,300 hospitals and health systems by Syntellis Performance Solutions and the AHA.
AHA urges CMS to swiftly correct MA plan policies that appear to violate CY 2024 rule
Certain Medicare Advantage organizations have issued policies for the coming year that AHA believes do not fully adhere to requirements in the MA final rule for calendar year 2024, the association alerted the Centers for Medicare & Medicaid Services Nov. 20.
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 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.