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AHCA Requests Updated MA Member Data to Assess Plan Implementation of New Regulations

The American Health Care Association (AHCA) is re-releasing its Medicare Advantage (MA) data initiative for 2025, building on its 2024 launch. AHCA members are asked to submit MA data for August 2025 (8/1–8/31) and/or September 2025 to help evaluate how plans are implementing new regulations, especially prior authorization processes for skilled nursing facility (SNF) care using this tool. The updated tracking tool also captures administrative costs tied to authorizations and appeals. All submissions will be de-identified and aggregated before sharing with the PAC Coalition and policymakers to strengthen advocacy for MA reforms and protect access to needed post-acute care. Reporting guidance is available in the instructions tab, and questions can be directed to AHCA Population Health Policy Analyst Rohini Achal.

This effort comes amid heightened federal oversight of MA practices. The Centers for Medicare & Medicaid Services' (CMS) 2024 Parts C and D Program Audit and Enforcement Report flagged issues including delays and inaccuracies in coverage determinations, poor communication, and compliance oversight gaps, while also reviewing new utilization management requirements for the first time.  A July 22 House Ways and Means Committee at a joint Health and Oversight Subcommittee hearing likewise stressed bipartisan support for MA but called for improvements, particularly around prior authorization, transparency, and incentives. Together, these developments underscore the importance of timely, comprehensive data collection to inform advocacy and policy change.

Staff contact: mcarland@mehca.org

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