OBJECTIVE
Medicare Advantage plans must cover at least the same services as original Medicare, but Medicare Advantage Organizations (MAOs) may impose additional administrative requirements, such as requiring prior authorization before certain services can be provided. Prior OIG work found that MAOs sometimes denied prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules. We will examine selected MAOs’ processes for reviewing prior authorization requests for post-acute care in long-term acute care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. We will also review the extent to which the selected MAOs denied requests for post-acute care and examine the care settings to which patients were discharged from the hospital.
There are 2 projects in this series.
ACTIVE PROJECTS IN THIS SERIES (2)
TIMELINE
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June 17, 2024Series Number SRS-E-26-004 Assigned
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June 17, 2024Projects Announced
Project OEI-09-24-00330
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Project OEI-09-24-00331
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Today2 Evaluations In-Progress
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Est FY2026Estimated Fiscal Year for Series Completion