October 18, 2024 Washington, DC — Health care provider group leaders, collectively representing approximately 35,000 providers of post-acute care nationwide, laud the findings revealed in the new report Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care, released Oct. 17 by the Senate Permanent Subcommittee on Investigations (PSI).
Built on evidence from the largest insurers in the Medicare Advantage (MA) program, this report reveals what far too many patients and providers already know: MA plans have dramatically scaled up care denials in recent years and are placing serious barriers to patients receiving the medically necessary care they need.
The following is a joint statement from LeadingAge, the American Medical Rehabilitation Providers Association (AMRPA), American Health Care Association/National Center for Assisted Living (AHCA/NCAL), National Association of Long Term Hospitals (NALTH), and the National Alliance for Care at Home (the Alliance):
“Our organizations, representing inpatient rehabilitation hospitals and units (IRFs), long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), and home health agencies (HHAs), have long raised concerns that MA plans too often inappropriately delay and deny access to post-acute care, causing real harm for patients seeking to fully recover from serious injuries, illnesses, disabilities, and chronic conditions. Our members consistently report that these MA plan practices have a direct negative impact on beneficiaries’ long-term health, function, and ability to maximize their recovery, especially when they limit access to benefits that are fully covered for those enrolled in Traditional Medicare.
“Among other findings, the PSI report reveals that UnitedHealthcare, Humana, and CVS/Aetna, covering the majority of all MA beneficiaries, denied admissions for post-acute care settings three times as frequently as for other services (in the case of Humana, more than 16 times more frequently) in 2022. While the Subcommittee’s report only covered data from 2019-2022, member reports across post-acute care settings indicate these trends have only continued to worsen. The report also raises serious concerns about plans’ use of artificial intelligence, algorithms, and other predictive technologies to curtail prior authorizations and potentially override the decision-making authority of reviewing clinicians employed by plans.
“Additional regulatory action must be taken to rein in these practices and ensure that beneficiaries enrolled in Medicare Advantage receive the care to which they are entitled in a timely fashion. Our organizations strongly support the recommendations in the report for enhanced oversight and enforcement by the Centers for Medicare and Medicaid Services (CMS), and we call on Congress and other federal policymakers to prioritize a comprehensive response to protect access to covered services, and particularly post-acute care. More must be done to ensure that millions of MA beneficiaries nationwide are not inappropriately barred from necessary medical care.”
