White House Moves To Crack Down On Medicare Advantage Care Denials
Final regulations issued Wednesday mean Medicare Advantage plans won't be able to reject coverage of care that would otherwise be covered for those enrolled in the traditional Medicare program, Stat explains. Nursing home payments, hospital executive compensation, and more are also in the news.
Stat:
Medicare Advantage Plans Will Have To Stop Denying Required Care
The Biden administration is moving forward with proposals that would crack down on Medicare Advantage insurers that deny care inappropriately — including if companies use algorithms to turn down coverage. Starting next year, Medicare Advantage plans cannot reject coverage of procedures, prescription drugs, tests, or supplies that would otherwise be covered if someone were enrolled in the traditional Medicare program, according to final regulations issued Wednesday. (Herman, 4/5)
Modern Healthcare:
CMS’s Medicare Advantage Final Rule To Speed Prior Authorizations
The Centers for Medicare and Medicaid Services' Medicare Advantage and Medicare Part D final rule for 2024 aims to further the agency's efforts to strengthen federal oversight of health insurance companies. CMS published the regulation Wednesday, which includes major changes to the standards for quality metics, prior authorizations, marketing and health equity. The agency issued the proposed rule in December. (Turner, 4/5)
Also —
Axios:
Nursing Homes Get A Payment Boost, But Staffing Standards Loom
With the threat of mandated staffing ratios looming over some long-term care facilities, the Biden administration on Tuesday said it will bump up Medicare payments to skilled nursing providers next year. Why it matters: Nursing homes are dealing with acute staffing shortages and operating with financial losses, and concerns about how CMS finalizes staffing regulations this spring have the industry on edge. (Dreher and Goldman, 4/5)
In other health care industry news —
Becker's Hospital Review:
Judge Denies Challenge To Measure That Would Cap LA Hospital Exec Pay
A Los Angeles judge has denied a challenge from the California Hospital Association to a ballot measure that would cap pay of hospital executives. The Los Angeles measure backed by Service Employees International Union-United Healthcare Workers West would cap hospital executive pay at the compensation of the U.S. president, or $450,000 per year. The California Hospital Association filed suit challenging the measure, arguing that the U.S. president earns more when factoring in travel expenses, discretionary funds and residence in the White House. (Gooch, 4/5)
AP:
Hospital: Treatment, Discharge Of Woman Who Died Appropriate
A woman who died after being discharged from a Tennessee hospital and forced to leave despite her pleas for more help received appropriate medical treatment, the hospital said, but changes were being made to security procedures. The findings from an internal investigation by Fort Sanders Regional Medical Center in Knoxville over its treatment of 60-year-old Lisa Edwards were released Tuesday, news outlets reported. (4/5)
Philadelphia Inquirer:
Independence Health Group's Profit Fell In 2022 As Utilization Increased
Independence Blue Cross’ parent company on Wednesday reported a steep decline in profits in 2022, as the pandemic waned and people again started using medical care in greater numbers. The biggest health insurer in Philadelphia — whose coverage lines include Medicaid, Medicare Advantage, and private insurance — had $575 million in operating income last year, down from $1.4 billion the year before. Revenue climbed to $27.4 billion from $24.7 billion. (Brubaker, 4/5)
KHN:
The Big Squeeze: More Enrollees And Smaller Networks Plague Some ACA Plans
The Affordable Care Act may be struggling with its own success. Record enrollment over the last two years brought more consumers into the market. At the same time, many insurers began offering smaller networks of doctors and hospitals, partly to be price-competitive. That combination left some patients scrambling to find an available in-network physician or medical facility. That can be a challenge, especially when enrollees must rely on inaccurate provider lists from their insurance company. (Appleby, 4/6)
