A surge of public and professional support arrived Friday as the comment period closed for a proposed federal rule that providers say could level the playing field with Medicare Advantage plans.
Industry leaders specifically cheered on a proposed change that will give MA beneficiaries a modified appeals process and more time to appeal care denials and shortened stays handed down by insurers.
“[The American Health Care Association] is committed to ensuring individuals in a Medicare Advantage plan have access to high quality care and timely, medically necessary services,” Martin Allen, senior vice president of reimbursement policy at AHCA told McKnight’s Long-Term Care News. “As such, AHCA strongly supports the provisions in the Medicare Advantage proposed rule related to beneficiary protections and enhancing access to care.”
The changes are vital to ensuring MA recipients have the time and resources they need to secure their benefits, agreed nonprofit aging services organization LeadingAge in its own public statement.
“LeadingAge strongly supports the proposal to remove two key barriers — timeliness of the request (24 hours) and whether the person has left the care site — to MA enrollees being able to have an independent review entity consider their appeal for a denial or discontinuation of non-hospital services,” the statement read. “Enrollees and their families could easily miss appealing within 24 hours of receiving the denial.”
A popular regulatory trend
Insurers have increasingly come under fire from the care sector, consumer advocates and policymakers in recent months — especially for alleged overuse of artificial intelligence in decision-making and aggressive care denials. The Centers for Medicare & Medicaid Services proposed another amended MA appeals process in late December for patients who believe they were put on observation stay status prematurely.
AHCA spoke firmly in support of this trend and called for further steps to be taken in the future.
“The proposals continue to move in the right direction,” AHCA wrote in its final public comment, “but additional provisions are needed to better align with the beneficiary and provider
protections available under the Medicare Fee-For-Service programs.”
Allen drew specific attention to enforcement of the rules changes.
“It is important that CMS ensures the beneficiary protections around prior authorizations and utilization management practices implemented this year are adhered to and plans are held accountable,” he said.
The proposed rule would ensure that the 51% of Medicare recipients who use MA would have access to the same appeals process as those with traditional Medicare. Only 11% of MA denials are currently appealed, but 82% of those appeals result in favorable decisions for recipients, according to KFF.
