Medicare Advantage and prior authorization

States Stepping Into Prior Authorization Void

While federal lawmakers continue to weigh how to address the problem of prior authorization requirements that cause delays in the delivery of health care, many state governments are acting more decisively by implementing prior authorization reforms of their own. This year, 10 states have enacted 18 laws designed to facilitate prior authorization of medical services and in 2023, nine states and the District of Columbia did so. In all, 23 states have introduced prior authorization reforms in recent years. At the same time, some health insurers have reduced the number of medical services for which they require prior authorization. The [...]

joe2024-08-28T10:39:07-04:00August 29, 2024|Medicare|

CMS Clarifies Medicare Advantage Rule

To help clarify its final Medicare Advantage rule for 2024, the Centers for Medicare & Medicaid Services has published an FAQ providing additional guidance to Medicare Advantage plans and Medicare-Medicaid plans about prior authorization for admission to post-acute-care facilities and plans’ future use of artificial intelligence (AI), algorithms, and other software tools in their coverage criteria and utilization management practices. The rule has broad implications for most health care providers but especially for post-acute-care providers, which the FAQ reflects by addressing major issues and long-running challenges for such providers, including prior authorization for discharge from acute-care hospitals into post-acute care, [...]

joe2024-02-08T21:14:52-05:00February 12, 2024|340b, Centers for Medicare & Medicaid Services, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care|

Federal Health Policy Update for February 8

The following is the latest health policy news from the federal government for February 2 - 8. Some of the language used below is taken directly from government documents. Congress Members of the Senate’s 340B bipartisan working group have released a discussion draft of legislation that would update the 340B prescription drug discount program. Last year the group sought stakeholder input on policy solutions that might provide stability and transparency to the 340B program to ensure that the program can continue to achieve its original intent of supporting entities serving eligible patients. Find a news release describing the discussion draft [...]

joe2024-02-08T20:43:44-05:00February 8, 2024|340b, Centers for Medicare & Medicaid Services, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|