WASHINGTON—LeadingAge, an organization aiming to support nonprofit aging services providers, released a statement from Katie Smith Sloan, the company’s president and CEO, in response to the U.S. Senate Permanent Subcommittee on Investigations’ report on Medicare Advantage’s denial of post-acute care. The report, “Refusal of Recovery: How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care,” was released Thursday, Oct. 17.
The statement made by Sloan is below.
“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,” Sloan said. “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, roundtables with and letters sent to policymakers and regulators, and 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-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 threatens our members’ viability.
“We thank Chair (Richard) 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 (that) our members will be able to provide them.”
The report from the U.S. Senate Permanent Subcommittee of Investigations can be found here.
