Medicare Report to Congress Highlights Program Challenges, Goals

A new report from a congressional advisory panel offered good and bad news for Medicare managed care companies.

The Medicare Payment Advisory Commission’s annual June report to Congress found that 95% of 37.5 million prior authorization requests by Medicare Advantage plans in 2021 had “fully favorable decisions.” And 80% of negative prior authorization decisions that year also had “fully favorable decisions” upon redetermination.

The findings come as Congress and regulators heighten their scrutiny of care denials by MA plans.

“Prior authorization has been identified as a major source of provider administrative burden, and can also be a health risk for ...