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| 18 June 2026 | |
| LeadingAge National Updates |
A June 11 OIG report found Medicare Advantage Organizations (MAOs) denied 12% of SNF prior authorization requests, with wide variation across plans. Critically, 95% of appealed denials were overturned, indicating most initial denials were inappropriate. Long-stay nursing home residents fared worse, facing denials 40% of the time versus 11% for other enrollees. Third-party contractor naviHealth denied SNF care at a 14% rate, with 97% of those denials overturned on appeal.
LeadingAge had requested the OIG review and continues advocating for MAO accountability, standardized prior authorization processes, and expedited appeals. CMS neither concurred nor disagreed with OIG's recommendations, leaving the path forward uncertain.
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