October 17, 2024 Washington, DC – Statement from Katie Smith Sloan, president and CEO, LeadingAge, on “Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care,” released October 17 by the U.S. Senate Permanent Subcommittee on Investigations:
“This report provides valuable substantiation of the concerns and issues we’ve shared— repeatedly—with the Centers for Medicare and Medicaid Services (CMS), members of Congress, and other stakeholders. Its data on denials of Medicare Advantage (MA) plans’ prior authorization requests for post-acute care occurring at rates far higher than other types of care, and the increase in the number of post-acute service requests that are subject to prior authorization, validate our nonprofit and mission-driven provider members’ experiences.
As we’ve expressed in various MA-related advocacy initiatives—including meetings and roundtables with and letters sent to policymakers and regulators, reports, and comments submitted to CMS—sharing the experiences of our members and the MA-plan beneficiaries they serve, MA plans engage in problematic behavior. As documented in this report, they use as tools a variety of mechanisms—from initial denials based solely on artificial intelligence (AI)-driven algorithms to increased requests for prior authorization and shorter durations of care approved—to control the amount of service they provide and curb their costs. By doing so, they profit at the expense of older adults as well as the providers who seek to care for them.
The plans’ behaviors revealed in this report, including their avoidance of provider engagement by instructing employees to withhold information on authorization decision-making and by restricting communication to online portals, as well as their strategic, deliberate decisions to grant or deny prior-authorization requests, cannot and should not continue. This deliberate denial of necessary and timely care harms the MA plan beneficiaries our nonprofit and mission-driven provider members serve and also threatens our members’ viability.
We thank Chair Blumenthal and the staff of the Permanent Subcommittee on Investigations for the extensive work that went into this explosive report. And we will continue our calls for action to ensure beneficiaries can access services they need and our members will be able to provide them.”
