Medicare Advantage Urged to Relax

Ranked among the top 150 “Health Care CFOs to Know” in 2014, Paul Generale works for Christus Health, an international, not-for-profit health system based near Dallas. Paul Generale’s responsibilities at Christus Health include post-acute and ambulatory services.

Estimates from the U.S. Department of Health and Human Services (HHS) show that 25 percent of Americans grapple with multiple chronic conditions such as congestive heart failure (CHF) and diabetes. The figure rises to 75 percent among people over age 65.

The ability to quickly transfer patients to appropriate levels of care and clinically appropriate settings is critical to ensure that they receive timely emergency care. Amid the COVID-19 infection rate surge, the Centers for Medicare & Medicaid Services (CMS) in August called upon Medicare-Medicaid and Medicare Advantage organizations to either relax or waive some prior authorization requirements. All Medicare-Medicaid and Medicare Advantage organizations have been reminded that they are free to waive these requirements whenever the situation demands such action.