Mid-stream shift: Trump team to weigh unfinished Medicare Advantage coverage rules, program’s future

The Biden administration over the last three years spearheaded efforts to rein in Medicare Advantage plans’ use of prior authorizations to deny care and cut short coverage for nursing homes. But at the end, it also left some pretty substantial decisions on the table for the incoming Trump team — seen by many as pro-Medicare Advantage. In this episode, Nicole Fallon, vice president of integrated services and managed care for LeadingAge, breaks down what we know about the future of MA. First up: What happens to updated rules for MA plans proposed by the Centers for Medicare & Medicaid Services in November? They called for more limits on artificial tools and automated denials of care, strategies that a 2024 Senate report found were being employed frequently to cut off access to post-acute services, particularly in nursing homes. What happens next with those proposals is unknown, says Fallon, noting that such policy updates are not required annually, although payment updates (also still pending approval for 2026) are. Trump’s new team at CMS could allow them to flounder and issue its own proposal (or not) for 2027. Of broader concern, however, is whether members of Congress and patients will be able to keep pressure on the federal government to adopt further improvements as some Trump appointees embrace the idea of growing MA even faster. “Our hope is that both Congress and the administration really recognize that, first we need to kind of shore up those foundational issues — like access to care, enforcement of the rules, some greater transparency and data collection and really being good stewards of those Medicare trust fund dollars — before we engage in that debate about whether MA for all is really the right strategic direction,” Fallon says in this episode hosted by McKnight’s Long-Term Care News Senior Editor Kimberly Marselas. Listen in to hear Fallon’s current expectations and more about what the change in administration could mean for addressing more challenging MA reimbursement concerns. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.