Morning Briefing
Summaries of health policy coverage from major news organizations
Medicare Advantage Plans Too Often Deny Care, HHS Watchdog Reports
USA Today: Medicare Advantage Plans Skimp On Claims, Care, Federal Report Finds
A government watchdog report released Thursday found private Medicare plans routinely rejected claims that should have been paid and denied services that reviewers found to be medically necessary. The report, completed by U.S. Department of Health and Human Services inspector general investigators, discovered private Medicare plans denied 18% of claims allowed under Medicare coverage rules. The denials often were a result of errors in processing claims, the report found. (Alltucker, 4/28)
The New York Times: Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds
Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday. The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials. Advantage plans have become an increasingly popular option among older Americans, offering privatized versions of Medicare that are frequently less expensive and provide a wider array of benefits than the traditional government-run program offers. (Abelson, 4/28)
Axios: Medicare Advantage Debate Rekindled By Report On Coverage Denials
"The OIG report validates that the vast majority of Medicare Advantage prior authorization requests are approved, and that the vast majority of denials that the OIG reviewed were appropriate," said Kristine Grow, a spokesperson for America's Health Insurance Plans, adding Medicare administrators noted plan performance is improving. (Reed and Owens, 4/29)
Meanwhile, in news from the Centers for Medicare & Medicaid Services —
Modern Healthcare: CMS Finalizes ACA Plan Standardization, Network Adequacy Policies
Insurers on Affordable Care Act exchanges will have to offer plans with standardized deductibles and limits on out-of-pocket costs and co-pays for each of non-standardized offerings, as well as meet stronger network adequacy requirements in 2023, under a new Centers for Medicare and Medicaid Services final rule issued Thursday. CMS did not finalize a change to the risk adjustment model for exchange plans that experts had cautioned could prompt insurers to cherrypick healthier consumers, and punted a proposed policy to explicitly prohibit sexual orientation and gender identify discrimination to a future rule. (Goldman, 4/28)
Modern Healthcare: CMS Finalizes Rule On Ownership Changes At Accreditation Groups
Accreditation organizations will need to notify the Centers for Medicare and Medicaid Services of a change in ownership at least 90 days before it occurs, according to a rule finalized by the agency Wednesday three years after it was proposed. Following the notice, CMS will determine whether the new ownership is equipped to accredit facilities and meet Medicare standards. CMS can't approve or disapprove business transactions, but it does need to ensure a new owner is eligible for Medicare participation, the agency said. (Goldman, 4/28)
