As the year draws to a close, lawmakers and advocates are discussing ways to improve Medicare Advantage in the future and tackling issues around prior authorization and marketing.
Here are seven Medicare Advantage updates Becker's has reported since Dec. 9:
- Sachin Jain, MD, president and CEO of SCAN Group, sat down with Becker's to discuss the company's recently announced combination with CareOregon, along with current and future trends in Medicare Advantage.
- Better Medicare Alliance, a pro-Medicare Advantage advocacy group, wants more frequent audits and more robust criteria for in-home health risk assessments for beneficiaries. The group issued a set of recommendations to improve the public-private partnership for 2024 and beyond.
- CMS issued a proposed rule to continue its efforts to overhaul prior authorization and marketing practices around Medicare Advantage and Part D plans, along with adding health equity measures to star ratings and boosting behavioral health network adequacy requirements.The proposed rule would also implement a key prescription drug affordability provision of the Inflation Reduction Act.
- Some Medicare Advantage plans that face auditing are granted hardship requests to exclude certain patient records, according to an investigation from Kaiser Health News. CMS said it approves around 20 percent of the hardship requests it receives.
- A group of Democratic senators and representatives are concerned about healthcare organizations with previous allegations of fraud and abuse, including multiple payers, participating in the ACO REACH program.
- Knowing where Medicare Advantage dollars are being spent is a top priority for CMS, Administrator Chiquita Brooks-LaSure said at the Milken Future of Health Summit. Ms. Brooks-LaSure said determining how supplemental Medicare Advantage benefits are being used is another top focus for the agency.
- Sponsors of the Improving Seniors' Timely Access to Care Act, designed to reform the Medicare Advantage prior authorization process, said the legislation is "one step closer to becoming law" after CMS released a proposed prior authorization improvement rule Dec. 6. The bill would establish an electronic prior authorization process and require Medicare Advantage plans to report to CMS the extent of their use of prior authorization and the rate of approvals or denials.