“Feds Rein In Use Of Predictive Software That Limits Care For Medicare Advantage Patients,” KFF Health News
Policy Suggestions
“The federal government will try to even the playing field next year, when the CMS begins restricting how Medicare Advantage plans use predictive technology tools to make some coverage decisions. About half the people eligible for full Medicare benefits are enrolled in the private plans, attracted by their lower costs and enhanced benefits, and a host of nonmedical extras like transportation. Insurers receive a monthly payment from the federal government for each enrollee, regardless of how much care they need. HHS OIG says this arrangement raises ‘the potential incentive for insurers to deny access to services and payment in an attempt to increase profits.’ Nursing home care has been among the most frequently denied services by the private plans — something original Medicare likely would cover, investigators found.”
LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:
What a pAIn for MA patients seeking LTC.
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