AHA responds to CMS request for information on Medicare Advantage data

The AHA May 29 submitted a letter to the Centers for Medicare & Medicaid Services responding to a request for information regarding Medicare Advantage data, urging CMS to increase oversight of the program.

"Timely and accurate information on MA plan performance and compliance with existing CMS regulations is critical to ensuring that those enrolled in MA plans are not unfairly subjected to more restrictive rules and requirements than Traditional Medicare, which are contrary to the intent of the MA program and run afoul of federal rules," AHA wrote. "The AHA continues to urge CMS to increase enforcement of existing MA regulations to protect Medicare beneficiaries from inappropriate delays and denials of Medicare-covered services. We believe data collection and reporting on plan performance metrics that are meaningful indicators of patient access are a critical component of an effective enforcement strategy and strongly support CMS efforts to require MA plans to submit additional information necessary to conduct appropriate oversight."

The AHA also raised concerns about certain prior authorization practices, access to post-acute care services, vertical integration of large, national insurers, and the timeliness of insurer payment for services, among other issues, suggesting additional data collection, reporting and policy changes that could help to improve oversight and transparency in these areas. Finally, the association discussed implications for the continued rapid growth in MA enrollment and how it may affect Traditional Medicare, as well as special considerations for rural and critical access hospitals that may be uniquely affected by growing MA penetration.