The Office of Inspector General (OIG) is taking a closer look at Medicare Advantage prior authorizations for post-acute care, except for home health, according to the June update of the OIG work plan.
A prior report found that Medicare Advantage Organizations (MAOs) sometimes denied prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules.
Under the new review, the OIG will examine selected MAOs' processes for reviewing prior authorization requests for post-acute care in long-term acute care hospitals, inpatient rehabilitation facilities and skilled nursing facilities. It will also review the extent to which the selected MAOs denied requests for post-acute care and examine the care settings to which patients were discharged from the hospital.
In a separate report, OIG will look at the use of Electronic Visit Verification (EVV) data for Medicaid personal care services.
EVV requirements were included in the 21st Century Cures Act in response to longstanding fraud, waste and abuse concerns associated with Medicaid personal care services. This evaluation will assess the availability and completeness of EVV data and examine how state Medicaid agencies and others use these data for program integrity purposes.
Both reports are expected to be completed in 2026.