AMA House of Delegates Calls on Medicare Advantage to Align Prior Authorization Policies with Medicare Fee-for-Service  

The American Medical Association (AMA) House of Delegates issued a statement saying that Medicare Advantage plans shouldn’t override physician judgment. According to a resolution presented at the AMA Special Meeting, more than 62 million Americans are covered by Medicare Advantage plans, yet such plans may not follow Medicare guidelines for hospital admissions, diagnostic testing, medication, and procedures, putting many—especially those with “long COVID”—at risk for being denied treatment.

To ensure that patients covered by Medicare Advantage plans are not denied necessary treatment, delegates directed the AMA to:

• Ask the CMS to further regulate Medicare Advantage plans so that the same treatment and authorization guidelines are followed for both fee-for-service Medicare and Medicare Advantage patients, including admission to inpatient rehabilitation facilities.
• Advocate that proprietary criteria shall not supersede the professional judgment of the patient’s physician when determining Medicare and Medicare Advantage patient eligibility for procedures and admissions.