Recently, the United States Centers for Medicare and Medicaid Services (CMS) issued a Request for Information regarding various aspects of Medicare Advantage (MA) data, building on the 2022 General MA Request for Information. CMS notes that one key theme that came out of comments submitted in response to that RFI was an interest in greater beneficiary protections, including strengthened MA marketing regulations and prior authorization protections. Commentors also focused on issues related to payment (including accurate risk adjustment and value-based payment arrangements between providers and insurers) and competition in the market (such as topics connected to insurer consolidation and vertical integration). CMS further received feedback on the importance of “comprehensive high-quality MA programmatic data” and promoting more program transparency by releasing MA data to the public.
CMS notes in the RFI that the agency has already finalized some policies and proposed more policies for improving MA data capabilities, including issuing requirements for collecting more data related to supplemental benefits in the updated Medicare Part C reporting requirements, requiring MA organizations to improve their prior authorization processes and final interoperability requirements, and collecting race and ethnicity data on a voluntary basis on MA and Part D enrollment forms.
The RFI, therefore, seeks to get input from the public on how the agency can meet the shared goals of enhancing data capabilities to provide better insight into programs, consider areas to increase MA data transparency, and propose future rulemaking. CMS notes that the agency’s “eventual goal is to have, and make publicly available, MA data commensurate with data available for Traditional Medicare to advance transparency across the Medicare program, and to allow for analysis in the context of other health programs like accountable care organizations, the Marketplace, Medicaid managed care, and integrated delivery systems.
CMS Seeking Comments and Input
CMS is seeking input on all aspects of data related to the MA program, with a particular interest in the following:
- Data-related recommendations related to beneficiary access to care including provider directories and networks.
- Prior authorization and utilization management, including denials of care and beneficiary experience with appeals processes as well as use and reliance on algorithms.
- Cost and utilization of different supplemental benefits.
- All aspects of MA marketing and consumer decision-making.
- Care quality and outcomes, including value-based care arrangements and health equity.
- Healthy competition in the market, including the impact of mergers and acquisitions, high levels of enrollment concentration, and the effects of vertical integration, data topics related to Medicare Advantage prescription drug plans (MAPDs).
- Special populations such as individuals dually eligible for Medicare and Medicaid, individuals with end stage renal disease (ESRD), and other enrollees with complex conditions.
By publishing the RFI, CMS is hoping to receive feedback from a wide variety of stakeholders, including beneficiaries and beneficiary advocates, plans, providers, community-based organizations, researchers, employers and unions, and the public. Importantly, CMS notes that “intimate knowledge of CMS’ current data availability or capability is not needed to provide input on the aspects of MA for which commenters think policymakers and the public should have more data.”
That being said, if a commenter has particular specialized knowledge (such as an academic researcher, data vendor, or other stakeholder with a deep understanding of MA data), CMS does ask that the commentor provide recommendations, including precise detail and definitions.
Comments submitted in response to the RFI should be submitted no later than May 29, 2024.