In April 2025, the American Hospital Association (AHA) released a report outlining the “key trends impacting hospital financial stability” in 2025. Entitled “The Cost of Caring: Challenges Facing America’s Hospitals in 2025,” it argues that there is a “perfect storm”… Read More ›
The Centers for Medicare & Medicaid Services (CMS) finalized important updates impacting prior authorization of care processes within the Medicare Advantage (MA) program. These changes, detailed in the CMS 2026 Medicare Advantage Final Rule (“Rule”), aim to enhance beneficiary protections… Read More ›
The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would significantly enhance regulations around how Medicare Advantage (MA) organizations use internal coverage criteria, particularly relating to prior authorization and utilization management. The proposed changes, part… Read More ›
Medicare Advantage insurers are using prior authorization requirements to systematically deny seniors access to post-acute care facilities, according to a recent U.S. Senate investigative report. Dated October 17, 2024, the Majority staff report of the Senate Permanent Subcommittee on Investigations… Read More ›
CMS is proposing revisions to the required metrics for the annual health equity analysis of the use of prior authorization. Under the proposed changes, MA organizations would have to report the metrics for the analysis by each item or service,… Read More ›
The Center for Medicare & Medicaid Services (CMS) released the CMS Interoperability and Prior Authorization Final Rule on January 17, 2024, which according to CMS.gov “emphasizes the need to improve health information exchange to achieve appropriate and necessary access to… Read More ›