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GAO says CMS should target behavioral health services in prior authorization audits
The Government Accountability Office May 29 released a report recommending the Centers for Medicare & Medicaid Services target behavioral health services when auditing Medicare Advantage plans’ use of prior authorization.
CMS to expand audits of MA plans
The Centers for Medicare & Medicaid Services May 21 announced it will immediately begin annual audits of all Medicare Advantage plans and work to clear a backlog of audits from 2018 through 2024.
CMS leaders share insights on deregulation, Medicare Advantage oversight
Leaders from the Centers for Medicare & Medicaid Services at the 2025 AHA Annual Membership Meeting May 5 discussed issues on the agency’s agenda in a fireside chat moderated by Ashley Thompson, AHA senior vice president, public policy analysis and development.
Health Care Plan Accountability Update: March 28, 2024 - July 8, 2024
The AHA May 29 submitted a letter to the Centers for Medicare & Medicaid Services responding to a request for information regarding Medicare Advantage data, urging CMS to increase oversight of the program.
Report: Hospitals and health systems squeezed by persistent economic challenges
The AHA April 30 released a report highlighting how hospitals and health systems continue to experience significant financial headwinds that can challenge their ability to provide care to their patients and communities.
CMS finalizes CY 2026 Medicare Advantage, Part D rates
The Centers for Medicare & Medicaid Services April 7 released finalized payment rates for calendar year 2026 Medicare Advantage and Part D plans.
CMS releases final rule for 2026 Medicare Advantage, prescription drug plans
The Centers for Medicare & Medicaid Services April 4 finalized changes to the Medicare Advantage and prescription drug programs for contract year 2026.
AHA discusses how Congress can improve support for post-acute care
The AHA March 11 shared ways Congress could better support patient access to post-acute care in comments for a hearing held by the House Committee on Ways and Means Subcommittee on Health.
AHA report examines how growth of MA heightens challenges for rural hospitals
A new AHA report highlights how certain practices by Medicare Advantage plans are increasing rural hospitals' vulnerabilities and threatening access to care in rural communities.
KFF: MA insurers made nearly 50 million prior authorization determinations in 2023
An analysis by KFF released Jan. 28 found that Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023. The finding reflects continued year-over-year increases from 2022 (42 million) and 2021 (37 million) as more people have enrolled in MA. KFF also found that in 2023 there was an average of nearly two prior authorization determinations per MA enrollee.