The Medicare Advantage preauthorization process and denials of care are a growing concern across the continuum, and nursing home operators and advocates — as well as federal lawmakers — are pushing more urgently for change.

Such concerns are not new, and already some action has been taken: the Centers for Medicare & Medicaid Services (CMS) has sought to stop diversions of patients away from skilled nursing facilities while ensuring more consistency between MA and traditional Medicare.

Nevertheless, these forthcoming changes haven’t eased the headaches faced by nursing homes nor allayed fears by advocacy groups. And legislative efforts to reign in MA plans need to be stronger, nursing home operators and advocates say.

“Insurance providers won’t pay for patients to stay because, per their guidelines, they were well enough to go home … it is just astronomical, the amount of patients that are discharged too early because the insurances will no longer pay,” said Laray Fayad, Regional Director of Care Connect and Census Development at Texas-based Focused Post Acute Care Partners (FPACP), which operates 27 nursing homes.

In the end, the burdens of cost and care are shifted to providers of health care across the continuum, Fayad told Skilled Nursing News, and quality gets compromised while rehospitalizations go up.

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