The Post-Acute Care (PAC) Medicare Advantage (MA) Coalition, which counts the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) and Leading Age among its members, has offered the Centers for Medicare and Medicaid Services (CMS) new proposals on how to improve MA prior authorization processes.

According to AHCA/NCAL, the submitted proposal seeks to ensure timely access to PAC services for Medicare beneficiaries, and to do so while reducing the administrative burden of prior authorization processes.  

The PAC submission includes two targeted solutions: 1. Standardize all prior authorization requests across MA plans; and 2. Reclassify all PAC-related PA requests and concurrent reviews as expedited and subject to a maximum 24-hour response time for coverage determination.

The coalition said these solutions aim to:

-          Ensure timely access to necessary PAC services for beneficiaries, supporting patient recovery and maintenance while preventing avoidable decline.

-          Reduce administrative burden for both plans and providers by increasing the increasing the likelihood of initial prior authorization approval and minimizing the need for repeated reviews.

-          Limit the number and frequency of subsequent requests for continued coverage determinations (e.g., concurrent reviews) within an episode of care.

“Importantly, these recommendations align with the Administration’s commitment to strengthen Medicare, unleash prosperity through deregulation, and increase operational efficiency,” the submission said.

“By streamlining processes, reducing duplicative documentation, and improving care coordination, these reforms protect taxpayer resources while enhancing the delivery of timely, appropriate care for Medicare beneficiaries and reducing the administrative burden on providers and plans.”

The coalition is comprised of LeadingAge, AHCA/NCAL, the American Medical Rehabilitation Providers Association, the National Alliance for Care at Home (the Alliance), the National Association of Long-Term Hospitals (NALTH), and the Center for Medicare Advocacy.

Read the full PAC proposal at https://tinyurl.com/3fyyh5kz.

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.