Bipartisan anger over Medicare Advantage denials on the rise

Concerns about Medicare Advantage denials are on the rise in Washington, Politico reported Nov. 24. 

Lawmakers are putting pressure on CMS to increase oversight of prior authorizations in the program. Earlier in November, 30 U.S. representatives wrote to CMS Administrator Chiquita Brooks-LaSure, asking the agency to require MA plans to report prior authorization data, including reasons for denials. 

"It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care," Senate Finance Committee Chair Ron Wyden told Politico. 

Plans are likely to face more scrutiny on Capitol Hill in 2024, Sean Creighton, managing director of policy for consulting firm Avalere Health, told Politico. 

"There will be more reporting requirements for the plans and actions the plans are required to take to lessen the burden on providers and patients," Mr. Creighton said. 

In its proposed Medicare Advantage rule for 2025, CMS proposed a health equity mandate for MA prior authorization, requiring plans to publicly report the results of an annual equity analysis of their prior authorization policies. 

Read Politico's full report here. 

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