On June 17, the Office of the Inspector General (OIG) added several new issues it will explore and evaluate in the coming years, with several focused on managed care in both the Medicaid and Medicare programs. LeadingAge is pleased to see that its March conversations with OIG staff on the prior authorization issues our skilled nursing facility and home health agencies face daily have borne fruit and OIG will be digging deeper into Medicare Advantage(MA) plan practices related to use of prior authorizations for post-acute care (PAC) settings.
OIG will be examining plan processes for reviewing prior authorization requests for PAC services, the extent to which these requests are denied and the setting that patients are discharged to following a hospital stay. They expect to issue a report in 2026. OIG will also be auditing MA plan compliance with federal requirements related to supplemental benefits offered to their enrollees with a report to be issued in 2025.
