Senators Query MA Plans on PAC Prior Authorization Denials

Recommend

Following recent Health and Human Services Office of Inspector General (HHS OIG) findings of continued and, in some cases, worsening barriers to post-acute care (PAC) access due to Medicare Advantage (MA) plans' prior authorization decisions, Senators Richard Blumenthal (D-CT) and Josh Hawley (R-MO), members of the Senate Permanent Subcommittee on Investigations (PSI), queried UnitedHealthcare, CVS/Aetna, and Humana chief executives about refusal of care.

LeadingAge advocated for the HHS OIG's examination of prior authorization practices in PAC because member experience suggested that aggregate MA prior authorization data across all services understated the challenges faced by beneficiaries when seeking post-acute care services.

In July 15, 2026 letters, the lawmakers seek information about Medicare Advantage(MA) prior authorization denials for post-acute care (PAC). In their letter to Humana, the senators noted that despite insurers' claims of reducing prior authorization burdens, the latest HHS OIG report findings indicate that the disproportionate impact of prior authorization on PAC has intensified. Similiar letters were sent to CVS and to UnitedHealthcare, per the senators' press release.

The senators have asked the plans to provide detailed information to PSI by July 28, 2026, covering 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 MA plan practices in SNFs.

The senators' letters also emphasize that limited public reporting has allowed MA organizations to avoid meaningful accountability.

Both senators are co-sponsors of the Improving Seniors' Timely Access to Care Act(H.R. 3514/S. 1816). The legislation would require more comprehensive prior authorization reporting and increased transparency around plan decision-making.

The bill is sponsored by Sen. Roger Marshall (R-KS) and more than 70 bipartisan Senate co-sponsors and nearly 297 members of the House. The House version of the bill has been approved unanimously by both the Ways & Means and Energy & Commerce committees as of July 21.

The resulting report found high rates of SNF service denials that were later overturned on appeal and also 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.