LeadingAge members—Rodolfo Parra, CEO at Holy Trinity Nursing and Rehab, Adam Berman, President of Legacy Lifecare and Steve Landers, CEO of Hebrew SeniorLife—joined physicians and representatives from Massachusetts hospitals in a March 4 Medicare Advantage roundtable held in Boston, Massachusetts. The roundtable was hosted by Senator Elizabeth Warren (D-MA) and CMS Administrator Chiquita Brooks-LaSure was in attendance to hear firsthand from providers about their experiences with Medicare Advantage plans.

Sen. Warren opened the roundtable by voicing her concerns with the growing dominance of MA plans and increasing reports of MA plan problems, including prior authorization delays and denials, inappropriate use of artificial intelligence algorithms to deny care, and deceptive marketing and upcoding practices. Administrator Brooks-LaSure’s remarks underscored the steps CMS has taken to address problems with the MA plans, including revisions to MA payment policies.

Providers were asked to share their experiences with challenges related to delays in prior authorization approvals, denials and appeals, contracting issues and network adequacy. Hospital representatives stressed the impact the prior authorization delays have on patients who cannot be discharged to a post-acute care setting and in turn, prevent hospitals from moving other emergency room patients, and those backed up in hallways, into these beds. Further, while these patients remain in the hospital awaiting their prior authorization to come through, they do not receive the necessary rehabilitation services in the hospital. LeadingAge members shared how delayed prior authorization decisions from the MA plans prevent them from admitting patients into their care, and the frustration when those services are terminated early before these individuals are capable of returning home safely. These Massachusetts providers echoed what LeadingAge often hears from members around the country that these issues are most prevalent with the large national MA plans operating in their markets and that they encounter fewer delays in service authorization from local MA plans because the provider can have a conversation with the local plans.

Sen. Warren asked providers for recommendations, which included: a need for same-day approvals (including weekends), fewer prior authorizations altogether (It was noted that the majority of prior authorizations are approved, which begs the question of why they are needed for routine services), and the need for MA plan accountability and transparency.