How Will Trump and Oz Handle Post Acute Medicare Advantage?

GAINING CLARITY: MA plans have faced bipartisan criticism for improper denials and delays of prior authorization requests, particularly for long-term care hospital (LTCH) and inpatient rehab facility (IRF) admissions. Nearly half of these requests are initially denied, though approximately 40% are overturned on appeal

With the new administration, industry players are looking for signs of a trend in the management of Medicare Advantage (MA) plans, reflecting ongoing efforts to control costs, improve quality, and address challenges such as fraud and access to care.

News Coverage

Christman, A. (2025, May 13). New CMS Innovation Center strategy holds promise for senior living Value-Based Care, MA plans. Senior Housing News. https://seniorhousingnews.com/2025/05/13/new-cms-innovation-center-strategy-holds-promise-for-senior-living-value-based-care-ma-plans/

Bloomberg, R. C. Z. (2025, April 29). CMS explores limiting insurers’ use of prior authorizations. Modern Healthcare. https://www.modernhealthcare.com/policy/cms-insurance-prior-authorizations/

Stulick, A., (2025, April 2). Long-Term Harm’: Former CMS chief warns HHS cuts will impact nursing home surveys, MA oversight. Skilled Nursing News. https://skillednursingnews.com/2025/04/long-term-harm-former-cms-chief-warns-hhs-cuts-will-impact-nursing-home-surveys-ma-oversight/

Siddiqi, Z., (2025, March 17). [UPDATED] Oz criticizes Medicare advantage, acknowledges nursing home staffing challenges at confirmation hearing. Skilled Nursing News. https://skillednursingnews.com/2025/03/oz-criticizes-medicare-advantage-and-expresses-optimism-about-tech-tools-for-nursing-home-staffing-at-confirmation-hearing/

Bannow, T. (2025, March 14). Dr. Oz pledges Medicare Advantage scrutiny: ‘There is a new sheriff in townSTAT. https://www.statnews.com/2025/03/14/dr-oz-confirmation-hearing-medicare-advantage-crackdown-medicaid-cms/

Johnson, Z. (2025, March 14). Providers and advocates urge House to take post-acute care off the ‘chopping block’ – McKnight’s Long-Term Care News. McKnight’s Long-Term Care News. https://www.mcknights.com/news/providers-and-advocates-urge-house-to-take-post-acute-care-off-the-chopping-block/

Siddiqi, Z., (2025, March 11). Medicare Advantage, Medicaid cuts deemed devastating for nursing homes at house hearing. Skilled Nursing News. https://skillednursingnews.com/2025/03/medicare-advantage-medicaid-cuts-deemed-devastating-for-nursing-homes-at-house-hearing/

Neuman, T., Biniek, J. F., & Freed, M. (2025, July 24). Will the Trump administration fast track the privatization of Medicare | KFF. KFF. https://www.kff.org/policy-watch/will-the-trump-administration-fast-track-the-privatization-of-medicare/

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