AHA: Legislative action needed to prevent MA plans from harming Medicare beneficiaries

MedCity News September 21, 2022
Marissa Plescia

AHA’s report comes after the U.S. House of Representatives passed the Improving Seniors’ Timely Access to Care Act, which would establish several requirements for the prior authorization process under MA plans. But AHA believes additional action is needed by the government.

Medicare Advantage plans use a series of policies that hurt Medicare beneficiaries, lead to physician burnout and bring up healthcare costs, the American Hospital Association (AHA) argued in a recent report. To combat these issues, AHA is calling for legislative action.

Specifically, AHA argues that some MA plans have stricter medical necessity criteria than traditional Medicare plans, use “excessive” prior authorization requirements, use unnecessary utilization management tools and require repetitive clinical documentation submissions for services.

“These practices result...

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