Provider groups and lawmakers have flooded the Federal Register with comments about the Centers for Medicare & Medicaid Services’ proposed Medicare Advantage and Medicare Part D rule released in December. Among other provisions, the rule would crack down on MA marketing practices and create requirements to increase access to behavioral health and culturally competent care.
LeadingAge urged CMS to ensure that MA enrollees have proper protections and access to services as the penetration rate of those private plans nears 50%.
“We want to ensure MA enrollees’ access includes up to 100 days of skilled nursing care (when medically necessary) and coverage for all medically necessary, 30-day home health episodes, as is permitted under traditional Medicare,” Nicole Fallon, LeadingAge vice president of health policy and integrated services, penned in a letter to CMS Administrator Chiquita Brooks-LaSure.
The Partnership for Quality Home Healthcare urged CMS to ensure continuity of care across all Medicare plans to prevent MA beneficiaries from being denied services covered under Medicare.
“We urge CMS to clarify that a home health plan of care, ordered by a physician or allowed
practitioner, which would be covered under traditional Medicare as a home health episode,
should be considered a “course of treatment” for which prior authorizations must be valid for
the duration of the entire plan of care,” Partnership CEO Joanne Cunningham wrote in her letter to CMS.
Senate Finance Committee Chairman Sen. Ron Wyden (D-OR), who released a report last year on deceptive advertising and marketing used by MA plans, urged CMS to crack down on MA plan fraud.
“It has become clear that not all enrollees are seeing that value or being put first,” Wyden said in his comments to CMS. “I strongly support the proposed rule as it seeks to restore important protections against deceptive and fraudulent marketing tactics, expands access to non-physician behavioral health providers, and promotes health equity for historically underserved communities.”
MA plans, which are less expensive than traditional Medicare fee-for-service plans, have been coming under increased scrutiny. Last year, the Office of Inspector General accused MA plans of denying or delaying services to beneficiaries covered under Medicare. A recent study by Kaiser Family Foundation found MA plans denied 6% (35 million) prior authorization requests for medical services in 2022.
