AHA Supports Medicare Advantage Improvement Act to Enhance Provider Accountability
The American Hospital Association (AHA), representing nearly 5,000 member hospitals and healthcare organizations, including physicians and nurses, has announced its support for the Medicare Advantage Improvement Act (H.R. 8375). This proposed legislation aims to address concerns within the hospital community regarding Medicare Advantage (MA) plans, which currently serve over half of all Medicare beneficiaries. The bill seeks to enhance accountability among commercial insurers, as certain MA plan policies may restrict beneficiary access, delay provider payments, and potentially increase healthcare costs.
Key components of the bill focus on resolving AI-driven prior authorization delays. It mandates standard approvals within 72 hours, expedited decisions within 24 hours, and real-time approvals for routine low-risk services. By integrating these processes with electronic health record systems, the bill ensures transparency through detailed data on prior authorizations, fostering compliance among MA plans. Enhanced patient and provider protection is prioritized by aligning coverage determinations with Medicare standards and appropriate clinical review processes, while also limiting retroactive denials.
Addressing specific challenges faced by post-acute care providers is another focus of the bill, as they continue to grapple with issues despite regulatory actions from the Centers for Medicare & Medicaid Services. The legislation aims to curb practices such as improper prior authorization, which can hinder access to essential post-hospital care. It also promotes network agreements, ensuring that beneficiaries have access to long-term care hospitals and inpatient rehabilitation facilities.
Additionally, the bill highlights the absence of prompt payment standards for MA plans. According to an AHA survey, 50% of hospitals and health systems report substantial unpaid claims exceeding six months. This delay impacts hospitals' ability to reinvest in patient care, exacerbating financial challenges. To address this issue, the bill proposes provisions for timely payments by designating qualifying claims as clean claims, ensuring they are paid under Original Medicare’s prompt payment schedules.
The AHA expresses gratitude for the legislative leadership addressing these issues and is eager to collaborate on the successful passage of this important legislation. By focusing on regulatory compliance requirements and efficient claims processing, the proposed law aims to streamline operations and support continuous investment in patient care within the healthcare system.