and John Falardeau
As Medicare Advantage (MA) plans become increasingly popular, now covering more beneficiaries than traditional Medicare, prior authorization (PA) has expanded
to include chiropractic services. Since late July, UnitedHealthcare (UHC), Optum Health Care Solutions (Optum), and Humana have all announced changes to their PA programs for select MA plans, which now include chiropractic manipulative therapy (CMT) services under certain circumstances. The changes begin as soon as next week for Humana (Aug. 29) and a few days later for UHC and Optum (Sept. 1).
UHC and Humana updated provider newsletters to announce the changes, while Optum sent targeted letters to those impacted. If you are unsure if this impacts you, please review the plans affected by the changes and access the prior authorization tools available from each company to ensure your clinic is prepared.
Notably, this policy will not affect traditional Medicare (Part B). Expanding PA also conflicts with efforts from Congress and the recent Centers for Medicare and Medicaid Services (CMS) rule that looks to streamline the prior authorization process and lessen the onerous procedure on the provider and the payer. Additional questions remain unanswered by the announcements above, and consolidation among payers makes it challenging to address concerns with decision-makers responsible for enacting such policy changes.
ACA is part of an active non-MD coalition in Washington that includes the provider groups affected by the PA changes. The coalition has requested a meeting to clarify the confusion created by the sudden changes and better understand how to address this problem. Simultaneously, we have requested a meeting with CMS personnel to see if they can explain how they view such policy changes in the context of the new prior authorization rules.
We will continue working for you to address this problem and will have more information soon.
Please use the following contact information to address your concerns to the correct place.
• UnitedHealthcare Provider Services: (877) 842-3210
• Optum: (800) 873-4575 or [email protected]
• Humana: (866) 430-8647
Dr. Anderson is chair of the ACA Medicare Subcommittee, and John Falardeau is ACA senior vice president, public policy and advocacy.
