For skilled nursing facilities, MA prior authorization demands, including repeated concurrent reviews, opaque denials, and post-authorization clawbacks, disrupt care delivery and threaten financial stability.
Senators widen probe into UnitedHealth nursing home practices
“In a Jan. 7 follow-up letter to UnitedHealth Group CEO Stephen Hemsley, the senators (Warren & Wyden) wrote they are renewing their inquiry “with heightened alarm” after the company failed to meaningfully respond to their initial request for information in August. The letter warns that if UnitedHealth fails to fully respond, the senators “will pursue answers to this critical inquiry using all tools at the Committee’s disposal.”
— Becker’s, January 8, 202
LeadingAge, PAC Coalition Provide CMS Solutions to Standardize, Expedite MA PAs
“The PAC coalition offered two detailed PA solutions to CMS: Require all MA plans to use a standard PA request form… Require all PAC PA requests to be treated as expedited with plan decisions required within 24 hours. Of note, the solutions also recommend that concurrent review requests should require abbreviated data that reflects only the new information on the beneficiary since the prior request (e.g. progress, clinical notes, changes in condition) and that MA plans should not require concurrent reviews more than once per week.”
— LeadingAge, November 12, 2025
It’s Time to Reaffirm the Promise of Medicare Advantage, Hammel Says
“Providers are struggling with pre-service denials, disruptions in care and payment clawbacks — even after pre-authorization has been achieved. There’s also the important issue of beneficiary access. When coverage decisions are reversed, providers can be left responsible for the bill.”
— McKnight’s Long-Term Care News, October 20, 2025
“There are challenges from pre-authorizations … with the hope of [MA plans] that folks will quit… most don’t, because they’re exhausted. That’s got to stop, because patients lose.”
— Skilled Nursing News, October 15, 2025
Top Democrat Demands More Detail from Medicare Insurers About Their Use of AI
Sen. Richard Blumenthal sent letters to UnitedHealth Group, Humana, and CVS Health (Aetna) requesting an inventory of AI products employed in patient care evaluation and coverage decisions, and asking companies to describe policies implemented since October 2024 to prevent AI tools from “unduly influencing” clinician work — following a Senate investigation finding that payment denials for seriously ill patients increased significantly after large Medicare Advantage insurers began deploying AI and predictive tools for coverage determinations.
— STAT News, October 9, 2025
Prior Authorization Continues to Bedevil Congress
“The latest version of prior authorization legislation, known as the Improving Seniors’ Timely Access to Care Act, was introduced in the House in May by Rep. Mike Kelly (R-Pa.) and Rep. Suzan DelBene (D-Wash.), and in the Senate by Sen. Roger Marshall, MD (R-Kansas). The bill has 186 House co-sponsors and 56 Senate co-sponsors.”
— MedPage Today, September 16, 2025
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