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Key Strategies for Monitoring Medicare Advantage Plan Compliance: New & Upcoming Rules

February 27, 2024
3 p.m. - 4 p.m.

NJHA is pleased to partner with the American Hospital Association to update healthcare providers across the continuum on health plan accountability with a focus on implementation of the new CY2024 Medicare Advantage rules.

Faculty: Terrence Cunningham, JD
Director, Administrative Simplification Policy
American Hospital Association

Major topics to include:

  • AHA’s health plan accountability strategy;
  • Refresher on provisions of the CY2024 MA final rule;
  • Intel from the hospital field on implementation of the new rules;
  • Metrics to monitor MA plan compliance;
  • Pathways to report violations of federal rules;
  • Other policy developments including the CY25 MA proposed rule and prior authorization regulations; and
  • Next steps on MA advocacy and insurer accountability
Questions to review:
  • What, if any, changes has your organization observed with respect to MA plans or coverage of MA claims since the new rules took effect 1/1?
  • Are MA plans complying with the Two Midnight Rule? If not, what are the barriers or plan rationales for denying or downcoding inpatient care to observation?
    • Are plans applying internal coverage criteria (e.g., InterQual or MCG) to evaluate inpatient admissions on top of the FFS Two Midnight Rule criteria?
    • When plans are applying internal coverage criteria, is it publicly available, transparent, and compliant with the standards of evidence CMS requires?
  • Are you seeing any emerging trends or plan practices that may be intended to circumvent the new rules?
  • How can AHA and NJHA help?

Learning Outcomes for this Session:
At the completion of the course, participants will be able to:
  • Summarize AHA’s health plan accountability strategy;
  • Describe metrics to monitor MA plan compliance;
  • List pathways to report violations of federal rules;
  • Identify next steps on MA advocacy and insurer accountability.

Nursing Home Administrators Licensing Board Statement:
This continuing education program is sponsored/conducted by the Health Research and Educational Trust of New Jersey (HRETNJ) and is in compliance with N.J.A.C. 8:34-7.3 to provide licensed nursing home administrator (LNHA) education credits accepted by the Nursing Home Administrators Licensing Board.

This education activity may only be used for continuing education credit and not to meet academic college credits.
This education activity has been approved for a total of 1.0 LNHA continuing education credits.

This event is pending 1.0 credits for ACHE.

The planning committee, presenters, facility, authors, and content reviewers have no conflicts of interest to disclose. Disclosure forms are required and reviewed for any issues. Speakers are required to present balanced and unbiased presentations. The presentation’s content has been reviewed and any bias has been eliminated.

Accreditation status does not imply endorsement by HRET, NJSNA, ANCC Commission on Accreditation of any commercial products displayed with this program.

After making your purchase (Members $0.00/Non-Members $49.00), you will receive 2 emails from Please allow up to 5 minutes for second email with the link to your course.

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