Org Leadership & Governance 4

AHA.ORG | PAGE 9 OF 162025 ADVOCACY AGENDA

Commercial Insurer Accountability

� Hold commercial health insurers accountable for ensuring appropriate patient access to care, including by reducing the excessive use of prior authorization, ensuring adequate provider networks, limiting inappropriate denials for services that should be covered and prohibiting certain specialty pharmacy policies, like insurer-mandated “white bagging,” that create patient safety risks and limit patient access to certain medications in hospital settings.

� Ensure stronger enforcement of federal rules related to Medicare Advantage through increased oversight and insurer scrutiny.

� Increase oversight and accountability of commercial health plans through increased data collection, reporting and transparency on core plan performance metrics that are meaningful indicators of patient access, such as appeals, denials and grievances, and reporting on using algorithms and arti!cial intelligence in utilization management programs.

� Establish a prompt payment standard for Medicare Advantage to ensure timely claims payment.

� Apply guardrails to insurer algorithms and arti!cial intelligence use to ensure these tools do not inappropriately create barriers for patients to access medical care.

� Ensure patients can rely on their coverage by disallowing health plans from inappropriately delaying and denying care, including by making unilateral mid-year coverage changes.

� Prevent improper insurer manipulation of oversight tools designed to ensure premium dollars are spent on patient care (e.g., medical loss ratio requirements).

� Advocate for regulatory and legislative solutions to prevent health plans from enacting inappropriate fees for electronic payments.