CMS seeks feedback on transparency in Medicare Advantage plans

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The Centers for Medicare and Medicaid Services is seeking feedback on how best to enhance Medicare Advantage data capabilities and increase public transparency.

CMS has sent out the request for information, with comments due by May 29.

The information solicited by the RFI will support efforts for MA plans to best meet the needs of people with Medicare, to ensure insurers appropriately use taxpayer funds and for the market to have healthy competition, CMS said. 

CMS is seeking data-related input from the public related to all aspects of the MA program, including access to care, prior authorization, provider directories and networks; supplemental benefits; marketing; care quality and outcomes; value-based care arrangements and equity; and healthy competition in the market, including the effects of vertical integration and how it affects payment. 

CMS is also seeking comments on improving MA data collection and release methods. 

WHY THIS MATTERS

Medicare Advantage plans now represent over 50% of Medicare enrollment.

Plans are reimbursed through a capitation per member, per month payment. The federal government is expected to pay MA health insurance companies over $7 trillion over the next decade. 

CMS has already taken several steps to improve transparency in this market and to improve data capabilities. 

The agency is collecting more data related to Medical Loss Ratios, new data streams for supplemental benefits costs and utilization, new data collection and public posting requirements related to prior authorization and new collection of race and ethnicity data. 

CMS has also increased requirements for the completeness of encounter data. 

THE LARGER TREND

Earlier this month, CMS released an Interoperability and Prior Authorization final rule that requires payers to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests.

On December 7, The  White House announced new actions to promote competition in healthcare, including increasing transparency in the Medicare Advantage insurance market and strengthening MA programmatic data. 

In November, CMS issued a proposed rule to tighten Medicare Advantage marketing.

ON THE RECORD

"Americans with Medicare who have managed care plans called Medicare Advantage should not feel like their healthcare is a black box," said HHS Secretary Xavier Becerra. "The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions. It deprives researchers and doctors of critical data to evaluate problems and trends in patient care. Transparency is key to the Biden-Harris Administration's effort to increase competitiveness and ensure that Medicare dollars are spent on first-rate healthcare."

"In healthcare, you can't improve what you don't know, and the way to know is with data. We need to have transparent Medicare Advantage data to see what's working and what's not working to inform our efforts to protect enrollees and drive high-quality care and competition," said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare. "Through this RFI, we look forward to engaging all parties interested in the Medicare Advantage program."

Email the writer: SMorse@himss.org