AHA Urges Senate to Simplify Medicare Advantage Prior Authorization

In a statement presented on May 8 to the Senate Budget Committee concerning the reduction of administrative burdens in healthcare, the American Hospital Association (AHA) urged Congress to streamline the prior authorization process within Medicare Advantage plans.

The AHA highlighted that these practices impose significant financial burdens on the healthcare system, leading to inappropriate payment denials and increased costs related to staffing and technology required to meet plan requirements. The organization emphasized that prior authorization demands are a major contributor to healthcare workforce burnout, as noted by Surgeon General Vivek Murthy, M.D., in a recent advisory identifying documentation burden, including prior authorization, as a significant factor in healthcare worker burnout.

To address these issues, the AHA recommended that legislators simplify and standardize prior authorization requirements; conduct more frequent audits of specific Medicare Advantage plans with a history of inappropriate denials or delays; establish a provider complaint process for suspected federal violations by Medicare Advantage plans; enforce penalties on plans that fail to comply with federal regulations; and clarify the role of states in overseeing Medicare Advantage plans.

Furthermore, the AHA called on Congress to implement prompt payment requirements for Medicare Advantage plans when services are provided by in-network providers, with interest penalties for delayed payments. The AHA also expressed support for legislation endorsing gold carding programs and for the Centers for Medicare & Medicaid Services (CMS) proposed rule to standardize claims attachments under HIPAA