Partner Gregory Etzel is quoted in a Bloomberg Law article about a recent report from the US Department of Health and Human Services Office of the Inspector General showing problems with several states’ prior authorization processes for Medicaid that resulted in incorrect coverage denials. Gregory discussed potential concerns that could emerge should the Centers for Medicare & Medicaid Services (CMS) ever create an appeals process for Medicaid similar to one that exists for Medicare Advantage.
“These states would have to develop their way to pay into the federal support process for appeals adjudication, which they don’t have right now,” Gregory said.
“If something like that were proposed by CMS, I think you would see state Medicaid agencies and managed care organizations likely react to those rules with negative comments suggesting that that kind of approach for Medicaid is cost prohibitive.”
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