CMS seeks input to strengthen Medicare Advantage data, transparency

The Centers for Medicare & Medicaid Services seeks input through May 29 on ways to strengthen Medicare Advantage data to guide policymaking and advance transparency. The request for information, which builds on a similar request in 2022, particularly expresses interest in data recommendations related to: beneficiary access to care, including provider directories and networks; prior authorization and utilization management, including care denials, appeals processes and use of algorithms; cost and use of supplemental benefits; MA marketing and consumer decision-making; care quality and outcomes; the impact of mergers, acquisitions and vertical integration; and special populations, such as individuals dually eligible for Medicare and Medicaid or with complex conditions.

AHA has urged CMS to hold MA plans accountable for inappropriately restricting beneficiary access to medically necessary care, including in comments responding to the 2022 RFI and recent comments on MA proposals for contract year 2025, which include recommendations on improving data collection and reporting necessary to conduct appropriate oversight of the MA program.