AAHomecare throws weight behind Medicare Advantage reforms

WASHINGTON – AAHomecare has sent letters of support to the sponsors of legislation in the House and Senate that would reform Medicare Advantage prior authorization, claims integrity and transparency.

In its letters to Rep. John Joyce, R-Pa., and Sen. Roger Marshall, R-Kan., the organization shared how the bills would address challenges that home medical equipment (HME) providers face daily and would improve access to medical necessary equipment for Medicare beneficiaries.

“These policy changes strengthen accountability across the system and ensure that beneficiaries receive the equipment and services they’ve already been promised and suppliers receive payment,” added Cadie McGonagill, senior director of payer relations for AAH. “These are reforms our members have been asking for, and they will make a real difference for the people we serve.”

The bills, H.R. 8375 and S. 4348, would:

• Require Medicare Advantage (MA) plans to respond to standard prior authorization requests within 72 hours and expedited requests within 24 hours. AAHomecare says these timelines would reduce delays that too often leave patients waiting for essential equipment and services.
• Prohibit MA plans from denying coverage for authorized items and services on medical necessity grounds once approval has been granted. AAHomecare says this safeguard is critical and overdue for both providers and the beneficiaries who depend on them.
• Require MA plans to publicly report prior authorization denial rates, appeal outcomes and approval timelines. AAHomecare says these transparency measures would give policymakers, providers and patients the data needed to identify abusive practices, drive systemic reform, and ensure that MA plans are fulfilling obligations to enrollees.

AAHomecare strongly urges providers to contact their members of Congress and advocate for the passage of the bills.

See co-sponsors and read the bill language in the House and Senate.