Becker's Healthcare November 21, 2023
Some Medicare Advantage plans are not planning to comply with new CMS guidance requiring plans to follow traditional Medicare’s standards for coverage decisions, the American Hospital Association alleged.
In a letter to CMS published Nov. 20, the AHA said it has received reports from some of its members that “certain [Medicare Advantage organizations] have indicated they do not intend to make changes to their utilization management programs in response to the new rule.”
In April, CMS issued its final rule for Medicare Advantage plans for contract year 2024. The rule established that MA plans cannot apply coverage standards that differ from traditional Medicare, except in cases where Medicare’s coverage criteria is not fully established.
In its letter,...
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