CMS will implement new risk adjustment payment rates, prior authorization requirements and network standards for Medicare Advantage plans in 2024.
Beginning in 2024, plans cannot impose any prior authorization requirements for any ongoing treatments during the first 90 days a member is enrolled in a plan.
Medicare Advantage plans will be required to establish a utilization management committee to review policies annually and ensure policies are in line with traditional Medicare's requirements.
https://www.beckerspayer.com/policy-updates/5-medicare-advantage-changes-coming-in-2024.html
Will the utilization committee fact check the AI decisions?
Beginning in 2024, plans cannot impose any prior authorization requirements for any ongoing treatments during the first 90 days a member is enrolled in a plan.
Medicare Advantage plans will be required to establish a utilization management committee to review policies annually and ensure policies are in line with traditional Medicare's requirements.
https://www.beckerspayer.com/policy-updates/5-medicare-advantage-changes-coming-in-2024.html
Will the utilization committee fact check the AI decisions?