Skilled nursing facilities continue to be subjected to authorization delays and uneven MA plan conduct pending legislative reform.
Bill Aims to Crack Down on Medicare Advantage Prior Authorizations for LTC, Including Nursing Homes
“The [bill] cuts through red tape and makes it easier for seniors on Medicare Advantage to access the treatments and services they need, when they need them. This bipartisan legislation is a common-sense fix that puts patients over paperwork.”
— Skilled Nursing News, May 23, 2025
Home Care Advocates Slam ‘Radical, Detrimental’ MA Overhaul Bill
“This is a radical, detrimental change: Congress has made decisions over the course of the benefit’s history that deliberately keep hospice separate from Medicare Advantage. Doing so ensures hospice remains a managed, holistic benefit outside of MA.”
— McKnight’s Home Care, May 22, 2025
‘Ill-Conceived’: Proposed Bill Would Require Medicare Advantage to Pay for Hospice Care
“While reforms are needed, these are not the right reforms and frankly, these would decimate both the MA plans and providers trying to provide care. Choice has been a fundamental piece of the Medicare program and one that needs to continue.”
— Skilled Nursing News, May 21, 2025
Senators Reintroduce Bill That Seeks to Reform Prior Authorization in Medicare Advantage
“Prior authorization is the number one administrative burden facing physicians today across all specialties. As a physician, I understand the frustration this arbitrary process is causing health care practices across the country and the headaches it creates for our nurses.”
— Fierce Healthcare, May 21, 2025
Nursing Home Relief: Bipartisan Bill Aims to Reform Prior Auth Among Medicare Advantage Plans
“We’ve got to let doctors focus on treating patients. True peer-to-peer deliberations will help to reduce stress and frustration in the prior authorization process—and that’s why I’m introducing the Medically Unnecessary Delays in Care Act of 2025. Doctors need to be able to make fast, life-saving decisions without a jungle of red tape to cut through.”
— Skilled Nursing News, March 28, 2025
Congress Allows Medicare Advantage to Deny Coverage
“Despite the bipartisan, bicameral support of this much needed overhaul of Medicare Advantage providers, the bill is currently in a pile of unaddressed issues that the 118th Congress just didn’t get to. Despite having it in front of them for five months, and despite passing nearly half the legislation of the 17 most recent congressional sessions, the bill that would keep MA beneficiaries from waiting inordinate amounts of time for routine care will have to wait for the next session to resume.”
— The Rowan Report, January 9, 2025
“We are proud to receive the endorsements of over 500 organizations. This consensus support shows the need for prior authorization reform. We look forward to working with congressional leadership to pass H.R. 8702 and deliver life-saving policies for America’s seniors.”
— U.S. Representative Suzan DelBene, December 13, 2024
Legislative Action Needed When Insurers Won’t Pay for Preauthorized Care
“Prior authorization should be sufficient to guarantee payment. It is unacceptable that a health plan gives a green light to medically necessary care and then retains or creates barriers to payment. It’s an affront to physicians, patients and employers; and leads to financial strain for practices and families.”
— American Medical Association, November 12, 2024
“Zimmet Healthcare Services Group has previously estimated that the skilled nursing sector loses nearly $275 million to lower reimbursement rates and denied payments for every 1% of the Medicare market that MA plans gain.”
— McKnight’s Long-Term Care News, November 1, 2024
Letter to the Honorable Chiquita Brooks-LaSure, Administrator
“Congress created the MA program to provide seniors and people with disabilities with private sector plan options that could offer care coordination and extra benefits. People with Medicare should be able to benefit from an array of plan choices that they can easily comprehend, with guaranteed, timely access to the medical care they need. We are concerned that MA plans are failing to deliver for seniors and Americans with disabilities on these critical goals.”
— U.S. Senate Finance Committee, October 29, 2024
Providers Express Support for MA Prior Authorization Reform Bill
“This bill helps provide the clarity and transparency needed in Medicare Advantage to help beneficiaries feel more confident that they are receiving the level of high-quality and timely care they need and deserve.”
— McKnight’s Long-Term Care News, June 16, 2024
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