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The AHA has worked to hold health plans accountable through letters, statements, white papers, member updates and earned media." data-id="91d68f81-6afe-4f62-9277-9bc6bac1e2ee" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target="_self"> <a class="we-mega-menu-li" title="Commercial health plan abuses must be addressed to ensure fair coverage for patients and providers. The AHA has worked to hold health plans accountable through letters, statements, white papers, member updates and earned media." href="/issue-landing-page/2024-01-22-health-plan-accountability" target="_self"> Commercial Health Plan Accountability </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="AHA can help hospitals and health systems prepare for and mitigate cyber threats with John Riggi, a recognized expert, as a powerful resource." data-id="b7cb126e-be9e-4e8e-8191-d807c7833fb9" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target="_self"> <a class="we-mega-menu-li" title="AHA can help hospitals and health systems prepare for and mitigate cyber threats with John Riggi, a recognized expert, as a powerful resource." href="/cybersecurity" target="_self"> Cybersecurity & Risk Advisory </a> </li> <li class="we-mega-menu-li" data-level="1" 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data-alignsub="" data-target=""> <a class="we-mega-menu-li" title="" href="/career-resources/certification-center" target=""> Certification Center </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="The American Organization for Nursing Leadership (AONL) is the voice of nursing leadership." data-id="dbdd62f1-6317-40d7-a99c-4898b2cdd8b1" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target="_self"> <a class="we-mega-menu-li" title="The American Organization for Nursing Leadership (AONL) is the voice of nursing leadership." href="https://www.aonl.org" target="_self"> American Organization for Nursing Leadership </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="" data-id="8f630cf9-9a33-4f81-aa14-86c4393ea2a5" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" 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Scan </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="HEAL is a dynamic collection of tools and resources focusing on practical, how-to solutions to help hospitals and health systems of all sizes build more inclusive and equitable communities." data-id="ab6930ff-2b0f-496f-abcb-a4e65a0f65b6" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target=""> <a class="we-mega-menu-li" title="HEAL is a dynamic collection of tools and resources focusing on practical, how-to solutions to help hospitals and health systems of all sizes build more inclusive and equitable communities." href="/heal" target=""> Health Equity Action Library (HEAL) </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="" data-id="e4199598-ca3d-4408-9cc5-a61ee90acd46" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" 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data-id="207b339b-5154-4328-b6af-322ec0c943d5" data-submenu="1" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target=""> <a class="we-mega-menu-li" title="" href="/calendar" target=""> Education & Events </a> <div class="we-mega-menu-submenu" data-element-type="we-mega-menu-submenu" data-submenu-width="" data-class="" style="width: px"> <div class="we-mega-menu-submenu-inner"> <div class="we-mega-menu-row" data-element-type="we-mega-menu-row" data-custom-row="0"> <div class="we-mega-menu-col span12" data-element-type="we-mega-menu-col" data-width="12" data-block="" data-blocktitle="0" data-hidewhencollapse="" data-class=""> <ul class="nav nav-tabs subul"> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="" data-id="add265cf-9609-4fe3-9869-20ca8a3a3d26" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target=""> <a class="we-mega-menu-li" title="" href="/calendar" target=""> Events & Webinars Calendar </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="The Leadership Summit offers strategies and tools to help organizations better serve their patients and communities while improving financial and operational goals." data-id="91db86a9-8c4e-4be6-a20c-241aa3b06c8f" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target=""> <a class="we-mega-menu-li" title="The Leadership Summit offers strategies and tools to help organizations better serve their patients and communities while improving financial and operational goals." href="https://leadershipsummit.aha.org/" target=""> AHA Leadership Summit </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="The AHA Rural Health Care Leadership Conference brings together top thinkers in the field, and offers you proven strategies for accelerating performance excellence and improving the sustainability of your rural hospital." data-id="b98d1547-377b-4e46-bea2-f64bb7138952" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target=""> <a class="we-mega-menu-li" title="The AHA Rural Health Care Leadership Conference brings together top thinkers in the field, and offers you proven strategies for accelerating performance excellence and improving the sustainability of your rural hospital." href="https://ruralconference.aha.org/" target=""> AHA Rural Health Care Leadership Conference </a> </li> <li class="we-mega-menu-li" data-level="1" data-element-type="we-mega-menu-li" description="" data-id="f1f9417d-bbf1-4ea9-9d5b-84a98698c732" data-submenu="0" data-hide-sub-when-collapse="" data-group="0" data-class="" data-icon="" data-caption="" data-alignsub="" data-target=""> <a 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class="container"> <div id="block-breadcrumbs"> <nav role="navigation" aria-labelledby="system-breadcrumb"> <h2 id="system-breadcrumb" class="visually-hidden">Breadcrumb</h2> <ol class="breadcrumb" style="margin-bottom:0;"> <li><a href="/"><i class="fa fa-home"><span class="sr-only">Home</span></i></a></li> <li><a href="/type/advocacy">Advocacy</a></li> <li><a href="/taxonomy/term/113">Letter/Comment</a></li> </ol> </nav> </div> </div> </div> <section id="page-content" class="spacer"> <div class="container"> <div class="row"> <div class="col-md-8"> <section class="content"> <div class="body"><p>September 17, 2024 </p><p>The Honorable Christi A. Grimm Inspector General <br>U.S. Department of Health and Human Services <br>330 Independence Avenue, SW Washington, DC 20201 </p><p><em><strong>Re: Medicare Advantage Organizations' Use of Prior Authorization for Post-Acute Care (Report Number OEI 09-24-00330)</strong></em></p><p>Dear Inspector General Grimm: </p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations and our clinician partners — including more than 270,000 affiliated physicians, two million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) applauds the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) for your recently announced review of <a href="https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000873.asp" target="_blank">Medicare Advantage Organizations' Use of Prior Authorization for Post-Acute Care</a>. </p><p>The AHA continues to be concerned about the policies and practices of certain Medicare Advantage Organizations (MAOs) that impede patient access to care and circumvent rules designed to ensure access and coverage parity between Medicare Advantage (MA) and Traditional Medicare. Hospitals and health systems continue to experience inappropriate denials and delays in care for MA beneficiaries consistent with the concerns raised by prior <a href="https://oig.hhs.gov/documents/evaluation/3140/OEI-09-16-00410-Complete%20Report.pdf" target="_blank" title="Prior HHS OIG work">HHS OIG work</a> that found MAOs sometimes denied prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules. As indicated by the mounting evidence of inappropriate insurer denials and delays of post-acute care services, further scrutiny of these practices is warranted. The AHA strongly supports investigation into and greater oversight of MAO practices, particularly as they pertain to access to post-acute care services. </p><p>In the following sections, we describe the experience of referring hospitals and post-acute care providers with problematic MAO practices that inappropriately limit access to Medicare-covered post-acute care services and/or fail to comply with federal rules. <strong>As described below, these practices have, in some cases, caused direct and irreversible harm to patients, stymieing their recovery from serious illness or injury and hindering restoration of their functional capabilities</strong>. These abusive practices further strain health care delivery system resources and capacity at referring general acute-care hospitals by imposing days- or weeks-long delays in the necessary authorizations to transition patients to the next site of care, while sometimes precluding patient access to post-acute care sites altogether. <strong>We hope the experiences of patients, hospitals and health systems shared in this letter will inform your examination of MAO use of prior authorization for post-acute care services. We also hope it will spur greater action to curb practices that harm Medicare beneficiaries and unnecessarily delay timely access to care</strong>. On behalf of our members, we would be pleased to serve as a resource for any additional data, examples or information that would be helpful as you conduct your inquiry into this important topic. </p><p>We also want to acknowledge not all MA plans are the same; many have active partnerships with providers in service of their shared patients/members and consistently act in good faith to follow the rules. To this end, we believe that enforcement actions should be targeted to MA plans that have a history of suspected or actual violations or whose performance metrics related to appeals, grievances and denials could be indicative of a broader problem warranting investigation. Every effort should be made in carrying out enforcement activities to ensure that undue burden is not placed upon MA plans that consistently act in good faith and adhere to federal rules.</p><p>View the details below.</p></div> <div class="paragraph-group"> <div class="field_paragraphs_text_with_heade"> <div> <div class="paragraph paragraph--type--paragraphs-text-with-headers- paragraph--view-mode--default"> </div> </div> </div> </div> <h4 class="page-header">Key Resources</h4> <div class="field_related_files file file--mime-application-pdf file--application-pdf"> <div> <article> <div class="field_media_file"><span class="file file--mime-application-pdf file--application-pdf"><a href="/system/files/media/file/2024/09/aha-applauds-hhs-oig-for-recently-announced-review-of-medicare-advantage-organizations-use-of-prior-authorization-for-post-acute-care-letter-9-17-2024.pdf" type="application/pdf" title="AHA Applauds HHS OIG for Recently Announced Review of Medicare Advantage Organizations' Use of Prior Authorization for Post-Acute Care">AHA Applauds HHS OIG for Announced Review of Medicare Advantage Organizations' Use of Prior Authorization for Post-Acute Care</a></span> </div> </article> </div> </div> </section> </div> <div class="col-md-4"> <div class="list-group"> </div> </div> </div> <div class="spacer"> <div class="views-element-container"> <section class="resource-filter-block top-level-view js-view-dom-id-6c487e42f517b8e1303c66acf94b5af6ab166c8177efd8f94c45ce4570b8a950 resource-block"> <div class="panel"> <header class="panel-heading"> <h3>Related Resources</h3> </header> <div class="panel-body"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-field-type"> <div class="field-content">Letter/Comment</div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/lettercomment/2024-11-11-aha-responds-cms-medicare-advantage-data-and-audit-proposed-protocol" hreflang="en">AHA Responds to CMS Medicare Advantage Data and Audit Proposed Protocol</a></span> </div><div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only">Public</div> </div></div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-type"> <div class="field-content">Advisory</div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/advisory/2024-08-20-new-medicare-advantage-question-and-complaint-process-provider-organizations" hreflang="en">New Medicare Advantage Question and Complaint Process for Provider Organizations</a></span> </div><div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta"> <div class="views-field-access-level access-type-member" data-toggle="tooltip" data-placement="bottom" title="Members only">Member</div> 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access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only">Public</div> </div></div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-type"> <div class="field-content">Letter/Comment</div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/lettercomment/2024-06-12-aha-support-house-improving-seniors-timely-access-care-act" hreflang="en">AHA Support of House Improving Seniors' Timely Access to Care Act</a></span> </div><div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only">Public</div> </div></div> </div></div> <div class="article views-row"> <div class="views-field views-field-field-type"> <div class="field-content">Advancing Health Podcast</div> </div><div class="views-field views-field-title"> <span 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