Close to 300 members of Congress are urging federal regulators to do more to reduce burdensome Medicare Advantage requirements that can slow the delivery of care to nursing homes and other patients.
The 61 senators and 233 Representatives signed a letter to the Centers for Medicare & Medicaid Services urging the agency to continue its recent efforts to “lessen administrative burden for providers.”
Chief among the proposals highlighted in the Wednesday request was a call for a real-time mechanism supporting quick electronic prior authorization (PA) decisions for routinely approved services.
“This mechanism would improve patient care and reduce provider burden while avoiding unnecessary delays,” reads the letter, which was spearheaded by Sens. John Thune (R-SD) and Sherrod Brown (D-OH). “Hundreds of organizations representing patients, physicians, hospitals and other healthcare experts have put their support behind an e-PA proposal that includes a real-time process for items and services that are routinely approved.”
In a 2024 Medicare and Medicare Advantage rule finalized in April, CMS began to initiate some changes to prior authorization requirements that have been broadly criticized by skilled nursing providers as blocking access to nursing home care that would be covered by traditional Medicare benefits. One long-time SNF payment expert told McKnight’s Long-Term Care News that nursing home stays and MRIs are the top two services denied by MA’s prior-authorization process.
The 2024 rule limits MA insurers to using prior authorizations only in cases when a diagnosis is unclear, which was expected to lead to easier transfers of hospital patients to nursing homes.
The lawmakers are asking CMS to adopt policies that further that effort and ensure immediate access to all kinds of care by:
- creating a deadline of 24 hours for MA plans to respond to prior authorization requests for urgently needed care, and
- requiring detailed transparency metrics
Read the rest of the article at McKnight’s Long-Term Care News.