Becker's Healthcare January 8, 2024
Hospital and payer groups were broadly supportive of proposed changes to Medicare Advantage prior authorization and broker compensation regulations.
CMS published its proposed Medicare Advantage rules for 2025 on Nov. 6. The agency pitched limiting plans’ payments to brokers and prohibiting plans from paying value-based bonuses to third-party marketing organizations.
CMS also proposed new requirements for plans to create utilization management review committees and have a health equity expert serve on these committees.
In comments submitted to CMS Jan. 5, the American Hospital Association said it supported the addition of utilization management committees but proposed additional oversight of the committees. The AHA pitched requiring a member of the utilization management committee be a provider from an organization...
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