Level the Playing Field
TORCH is working with the Texas congressional delegation to identify solutions that address an array of hospital financing and operational challenges around Medicare Advantage plans and their effect on patients’ access to care.
MEDICARE ADVANTAGE CHALLENGES:
Growing enrollment in private Medicare Advantage plans is disrupting care for rural seniors, creating onerous administrative burdens for health care providers, and destabilizing rural hospitals’ finances. For healthy seniors in large metro areas who have predictable and minimal health care needs and sufficient financial resources, Medicare Advantage plans may be a prudent coverage choice. For more vulnerable rural seniors, however, these plans often fail to deliver what they promise, creating financial hardship and delaying -- and even denying access to -- medically necessary care.
SOLUTIONS FOR LAWMAKERS:
To make Medicare Advantage more effective at delivering on Medicare’s promise for seniors and be a better partner with rural hospitals at achieving Medicare’s strategic aims for “equitable, high quality, and whole-person care that is affordable and sustainable,” TORCH recommends the following legislative and regulatory solutions:
1. Allow hospitals to count Medicare Advantage patients as Medicare (not commercial) patients on required Medicare cost reports.
2. Protect cost-based reimbursement for designated critical access hospitals.
3. Require MA plans to recognize Medicare rural extender programs, including the low-volume hospital adjustment Medicare-dependent hospital designation.
4. Require MA plans to reimburse hospitals for services at an amount at least equal to current Medicare rates for approved services.
5. Standardize the complaint process for hospitals and other providers experiencing payment delays or denials.
6. Collect and publish data regularly on prior authorization denial rates and payments for common procedures for every MA plan compared with traditional Medicare.
7. Issue standards so that approval or denial of prior authorization requests are timely and available overnight and on weekends.
8. Allow rural hospitals with a track record of quality outcomes and history of low denial rates to be exempt from cumbersome prior authorization processes.
DOWNLOADS:
Attached are some Medicare Advantage advocacy pieces that can be used with members of the Texas delegation to garner support for leveling the playing field for rural hospitals and clinics with Medicare Advantage plans.
TORCH is working with the Texas congressional delegation to identify solutions that address an array of hospital financing and operational challenges around Medicare Advantage plans and their effect on patients’ access to care.
MEDICARE ADVANTAGE CHALLENGES:
Growing enrollment in private Medicare Advantage plans is disrupting care for rural seniors, creating onerous administrative burdens for health care providers, and destabilizing rural hospitals’ finances. For healthy seniors in large metro areas who have predictable and minimal health care needs and sufficient financial resources, Medicare Advantage plans may be a prudent coverage choice. For more vulnerable rural seniors, however, these plans often fail to deliver what they promise, creating financial hardship and delaying -- and even denying access to -- medically necessary care.
SOLUTIONS FOR LAWMAKERS:
To make Medicare Advantage more effective at delivering on Medicare’s promise for seniors and be a better partner with rural hospitals at achieving Medicare’s strategic aims for “equitable, high quality, and whole-person care that is affordable and sustainable,” TORCH recommends the following legislative and regulatory solutions:
1. Allow hospitals to count Medicare Advantage patients as Medicare (not commercial) patients on required Medicare cost reports.
2. Protect cost-based reimbursement for designated critical access hospitals.
3. Require MA plans to recognize Medicare rural extender programs, including the low-volume hospital adjustment Medicare-dependent hospital designation.
4. Require MA plans to reimburse hospitals for services at an amount at least equal to current Medicare rates for approved services.
5. Standardize the complaint process for hospitals and other providers experiencing payment delays or denials.
6. Collect and publish data regularly on prior authorization denial rates and payments for common procedures for every MA plan compared with traditional Medicare.
7. Issue standards so that approval or denial of prior authorization requests are timely and available overnight and on weekends.
8. Allow rural hospitals with a track record of quality outcomes and history of low denial rates to be exempt from cumbersome prior authorization processes.
DOWNLOADS:
Attached are some Medicare Advantage advocacy pieces that can be used with members of the Texas delegation to garner support for leveling the playing field for rural hospitals and clinics with Medicare Advantage plans.
- Leveling the Medicare Advantage Playing Field for Rural Hospitals and Clinics
- Get a detailed look at how rural providers and patients are negatively affected by program features in Medicare Advantage plans and explore some of the proposed solutions.
- Protecting the Value of Federal Critical Access Hospital Designation
- For Critical Access Hospitals, TORCH outlines the critical challenges and unique solutions lawmakers can prioritize to bring immediate relief to their communities.
- For Critical Access Hospitals, TORCH outlines the critical challenges and unique solutions lawmakers can prioritize to bring immediate relief to their communities.
