According to an article published by the American Hospital Association (AHA), the Centers for Medicare & Medicaid Services (CMS) should require Medicare Advantage (MA) plans to submit additional data and the agency should publicly release the MA data it already collects, a bipartisan group of senators told the agency last week. The letter requests a staff-level briefing by Dec. 27 on CMS’ plan to improve its data collection and reporting practices for MA plans.
“Without publicly available plan-level data on prior authorization requests by type of service, timeliness of determinations and reasons for denials; claims and payment requests denied after a service has been provided; beneficiary out-of-pocket spending; and disenrollment patterns, policymakers and regulators are unable to adequately oversee the program and legislate potential reforms,” wrote Sens. Elizabeth Warren, D-Mass.; Bill Cassidy, R-La.; Catherine Cortez Masto, D-Nev.; and Marsha Blackburn, R-Tenn.
AHA has urged CMS and the Department of Justice to hold Medicare Advantage plans accountable for inappropriately restricting beneficiary access to medically necessary care; and CMS to rigorously enforce changes included in the calendar year 2024 MA final rule to improve enrollee access and reduce administrative burden for providers and patients.
