Medicare & Medicaid Policy
Expert articles and analysis related to medicare & medicaid policy.
AI Summary — Last 24 Hours
Congress is moving to block CMS’s Medicare AI prior authorization pilot (WISeR), intensifying scrutiny of the Trump administration’s use of automation in utilization management as lawmakers warn it could delay care for seniors (Healthcare Dive). At the same time, new HHS OIG findings show Medicare Advantage plans—especially large MAOs—frequently deny post-acute admissions for skilled nursing, long-term acute care, and inpatient rehab, then overturn many denials on appeal, reinforcing pressure for tighter MA oversight, better encounter-data accountability, and more transparent prior authorization rules ([HHS OIG](https://news.google.com/rss/articles/CBMisAJBVV95cUxNd0J6dk9BY3ZHNjRwTDh0NTFjWUhSVEVveDRsMnpaSVZRSWZOMjI3OGppQWJ3OVE5ZTJWeE5WUFR1SnhwaHBVRC15QUdFcU1BbHpOa1lpM0xVTjBZTEVlQWVhd29XekZkSzRLZWJQcWRqYlpLWTJ0c2xJLWVVWTdmUFJZME9id3VaeHRzVTlWM0doZHdkb2prMDV
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The Three Largest Medicare Advantage Organizations Denied Requests for Long-Term Acute Care and Inpatient Rehabilitation at Some of the Highest Rates - Office of Inspector General (.gov)
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