AHCA/NCAL and its Post-Acute Care (PAC) Coalition partners recently submitted
recommendations to the Centers for Medicare and Medicaid Services (CMS) on improving Medicare Advantage (MA) prior authorization (PA) processes. The proposals aim to ensure timely access to PAC services for Medicare beneficiaries while simultaneously reducing the administrative burden associated with PA processes.
Key solutions include requiring all MA plans to adopt a standard PA request form (see
sample form) and reclassifying all PAC-related PA and concurrent review requests as expedited, with decisions issued within 24 hours. The Coalition also recommended limiting concurrent review requests to no more than once per week and including only updated patient information.
These recommendations serve to strengthen commitments and efforts by insurers and the Administration and ensure those efforts extend to PAC. This initiative builds on the coalition’s prior work and complements AHCA’s ongoing advocacy for regulatory and legislative changes to reaffirm the promise of MA and ensure beneficiaries receive medically necessary care.