Bipartisan Senate Inquiry Seeks Answers from Top 3 MA Plans on PAC Prior Authorization Denials
On July 15, Senators Richard Blumenthal (D-CT) and Josh Hawley (R-MO), members of the Senate Permanent Subcommittee on Investigations (PSI), sent letters to UnitedHealthcare, CVS/Aetna, and Humana seeking information about Medicare Advantage (MA) prior authorization denials for post-acute care (PAC). The request follows recent Health and Human Services Office of Inspector General (HHS OIG) findings showing continued and, in some cases, worsening barriers to PAC access. In their letter to Humana, the senators noted that despite insurers’ claims of reducing prior authorization burdens, the latest OIG data indicates that the disproportionate impact of prior authorization on PAC has intensified. The senators have asked the plans to provide detailed information by July 28, 2026, on prior authorization requests, denials, appeals, review processes, and the use of artificial intelligence tools from January 1, 2023, to the present.
LeadingAge is pleased to see they also requested data on the MA plans practices related to issuance of Notices of Medicare Non-Coverage (NOMNCs) issued in skilled nursing facilities (SNFs), including the number issued, average length of stay before issuance, appeal rates, and appeal outcomes. This reflects concerns frequently raised by LeadingAge members regarding Medicare Advantage plan practices in SNFs.
The letters also emphasize that limited public reporting has allowed MA organizations to avoid meaningful accountability. The senators’ inquiry aligns with the goals of the Improving Seniors’ Timely Access to Care Act (H.R. 3514/S. 1816), sponsored by Sen. Roger Marshall (R-KS) and more than 70 bipartisan Senate co-sponsors, including Sens. Blumenthal and Hawley. The legislation would require more comprehensive prior authorization reporting and increase transparency around plan decision-making. The House companion bill recently passed the Ways & Means Committee and is scheduled for consideration by the House Energy and Commerce Committee on July 20. LeadingAge advocated for the HHS OIG’s examination of prior authorization practices in PAC because member experience suggested that aggregate MA prior authorization data understated the challenges faced by beneficiaries and providers. The resulting report found high rates of SNF service denials that are later overturned on appeal and showed that 40% of requests for SNF care following hospitalization by long-term care nursing home residents were denied. These findings continue to strengthen the case for the Improving Seniors’ Timely Access to Care Act by highlighting the need for greater transparency and accountability in MA prior authorization practices. For additional details, the press release from Sens. Blumenthal and Hawley can be read here and the letter to the Humana CEO requesting information and accountability here.
House Ways and Means Committee Advances Bipartisan Bill to Ensure Nursing Home Residents’ Access to Essential Caregivers
The House Ways & Means Committee held a markup session on July 15, 2026, advancing bipartisan legislation that would establish federal requirements for essential caregiver access in nursing homes and other post-acute and long-term care settings during periods when visitation restrictions are in place. Reps. Claudia Tenney (R-NY) and John Larson (D-CT) originally introduced the Essential Caregivers Act of 2026 as a response to stories from their constituents who were unable to visit loved ones in nursing homes during the COVID-19 pandemic. The committee worked with stakeholders to revise the bill in advance of the markup and approved the amended legislation by a unanimous 38-0 vote.
As amended, the bill would allow each nursing home resident to designate up to two essential caregivers who could continue in-person visitation during a visitation restriction period, with one caregiver permitted to visit at a time. If a resident is unable to make that designation, a resident representative could do so. To ensure the safety of nursing home staff, the legislation would permit nursing homes to implement safety protocols consistent with guidance from the Secretary of Health and Human Services and would allow restrictions on essential caregivers who exhibit symptoms of a serious infectious disease or who do not follow required safety protocols. The bill also contains provisions related to end-of-life visitation, complaint investigations, and applicability to long-term care hospitals, inpatient rehabilitation facilities, and intermediate care facilities for individuals with intellectual and developmental disabilities.
LeadingAge has not taken a formal position on the legislation but has been actively engaged with congressional offices throughout the drafting and revision process. We will continue working with lawmakers as the bill moves forward to help ensure residents maintain access to loved ones during future visitation restrictions while preserving the flexibility and support nursing homes need to protect residents, staff, and visitors during infectious disease outbreaks. The bill’s next step would be consideration by the full House, but it is up to House leadership to decide which bills get brought to the floor for consideration, so the timing of any future action is unclear. LeadingAge will also continue to monitor whether any provisions of the bill might be included in a broader legislative package.
HealthDirect Pharmacy and United Healthcare Reach Agreement
LeadingAge has received word that HealthDirect, a long-term care pharmacy, has secured a contract agreement with United Healthcare/Optum (UHC) allowing them to continue to serve UHC Medicare Advantage and Part D plan enrollees. HealthDirect communicated to its customers that this means that they will be able to “continue to fill medications and bill transactions as we have up to this point, without disruption to resident care.”
OIG Audit Finds $19.5 Million in Improper Medicare Part B Payments for Services Provided in Nursing Homes
On July 20, the Department of Health and Human Services Office of Inspector General (OIG) released an audit finding that one Medicare Administrative Contractor (MAC), Novitas Solutions, improperly paid an estimated $19.5 million for certain Medicare Part B services furnished to beneficiaries residing in nursing homes. The audit reviewed claims for the period from October 1, 2018, through September 30, 2019, for evaluation and management, psychotherapy, and podiatry services and found that 91 of the 150 sampled claims did not meet Medicare requirements or documentation standards. Based on those findings, OIG estimated that millions of dollars in payments were made for services that should not have been reimbursed.
The report focused on Novitas’ oversight of claims in one of its jurisdictions rather than on nursing homes themselves, but it underscores continued federal scrutiny of Medicare billing and documentation practices in post-acute and long-term care settings. The OIG recommended that Novitas strengthen its claims review processes to prevent future improper payments and provide annual education to providers and their billing staff specific to the Medicare requirements. Providers should expect ongoing attention from regulators and Medicare contractors on documentation supporting Part B services furnished to nursing home residents.
OIG Announces Project on Hospice Payments for Care Provided in Nursing Homes
On July 15, the Office of Inspector General (OIG) updated its current workplan to include a new project looking at fixed daily rates paid to Medicare hospices serving residents in nursing homes. Hospices are paid the routine home care rate, which includes personal care, for care in nursing homes but nursing homes are also required and paid to provide these services as well. OIG will look at how this payment system undermines the efficiency of Medicare payments and adds to the incentives that bad actors have to exploit the program. This review will determine Medicare payments for routine home care provided to hospice beneficiaries in nursing homes, estimate potential cost savings from reducing the payment to address the inefficiency in the payment structure, and examine practices of hospices with a high percentage of their beneficiaries in nursing homes. The Hospice CARE Act, legislation that LeadingAge is deeply involved in, includes consideration of differential payments for hospices serving patients in nursing homes and the Centers for Medicare and Medicaid Services (CMS), as part of the FY2027 Hospice Wage Index Rule, proposed a measure of utilization to track hospices with significant numbers of nursing home patients.
Senate, House Members Reintroduce the Welcome Back to the Health Care Workforce Act
Senators Tim Kaine (D-VA) and Lisa Murkowski (R-AK) and Representatives Raja Krishnamoorthi (D-IL) and Adam Smith (D-WA) introduced the Welcome Back to the Health Care Workforce Act on July 16. This bill would help internationally educated health care professionals overcome common barriers to entering the health care workforce in the United States. It would create a grant program administered by the Health Resources and Services Administration to:
- Support communities in developing local- and state-level partnerships between health care organizations, community-based organizations, higher education, and state and local governments to help connect internationally educated health care professionals with the resources they need to enter the health care workforce.
- Address barriers internationally educated health care professionals trying to enter the health care workforce face by:
- Assisting with obtaining overseas academic or training records and providing support throughout the U.S. licensing and credentialing process.
- Developing work-readiness, peer support, mentoring, and culturally competent career counseling opportunities.
- Establishing opportunities to complete necessary prerequisite courses, continuing education training, and English-language learning.
- Supporting growth opportunities to address classroom and clinical instructor shortages.
- Giving priority to partnerships focused on supporting health care workers serving rural communities or filling a workforce shortage within a community.
House Leadership Releases a Continuing Resolution
The federal government runs out of funding on September 30. On July 16, House leadership put out a continuing resolution that would fund the federal government at current levels through December 4. Given that FY2027 appropriations are not on track to pass through regular order by September 30, LeadingAge supports a clean continuing resolution that would keep our programs funded while appropriations negotiations continue. It is not clear yet whether this CR will move forward.
Weekly Recaps: July 22, 2026
- Affordable Housing Weekly Recap.
- Home Health Weekly Recap.
- Hospice Weekly Recap.
- Life Plan Community Weekly Recap.
- Medicaid, HCBS, and PACE Weekly Recap.
- Nursing Home Weekly Recap.
- There is no Workforce Policy recap this week.
