Lawmakers call for Medicare Advantage prior authorization, overpayment reforms

A group of 70 lawmakers is pressing CMS on further Medicare Advantage reforms, and the agency is considering implementing prior authorization reforms and other changes to the program. 

The lawmakers signed on to a Feb. 16 letter to the agency, led by three Democrats: Washington Rep. Pramila Jayapal, Connecticut Rep. Rosa DeLauro and Illinois Rep. Jan Schakowsky. 

"Inappropriate care delays and denials within MA are harming seniors and people with disabilities," the lawmakers wrote. 

In the letter, representatives voiced support for CMS' proposed rules to improve prior authorization in the program, including requiring an approved prior authorization request to remain valid for a member's entire course of treatment and requiring coverage determination to be reviewed by relevant professionals. 

The proposed rule also received praise from physician groups. 

In addition to prior authorization changes, the representatives want CMS to: 

  • Require MA plans to cover services from any medical provider that accepts Medicare's approved rate.

  • Develop a more accurate risk scoring model based on patient demographics to reduce overpayments. 

  • Reinvest savings from MA overpayments into lowering Medicare premiums and improving care. 

 

Read the full letter here. 

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