LeadingAge applauds the December 7th bipartisan letter sent to CMS Administrator Chiquita Brooks-LaSure from Sens. Elizabeth Warren (D-MA), Catherine Cortez Mastro (D-NV), Bill Cassidy (R-LA), and Marsha Blackburn (R-TN) calling for more transparency in the Medicare Advantage (MA) program. The letter outlined the current shortcomings in MA data collection and reporting efforts and the specific data points that would bring greater transparency to how MA plans handle coverage determinations, prior authorizations, and appeals. In addition, the senators urged CMS to collect more information from plans that will help the policymakers and others assess whether the plans’ processes in these areas result in wrongful denials of care, inequitable access to care for certain populations and/or MA enrollees choosing to disenroll and why. The senators noted the growing influence of MA in the Medicare program and therefore, the need for better data to understand the effects MA is having on costs, coverage, and quality.
LeadingAge has recommended CMS require similar data reporting from MA plans in recent years and they agree that greater transparency can be achieved by collecting more detailed information at the plan-level. The senators specifically want CMS to collect the following data points: the number of prior authorizations, denials and appeals by service type and the reason for the denial; the timeliness of plans’ prior authorization decisions; beneficiaries’ utilization of supplemental benefits and related out-of-pocket costs; more complete encounter data to ensure plan compliance on coverage determinations and that certain groups are not disadvantaged through this decision making; along with seeking disaggregated disenrollment data to better understand the characteristics of the individuals disenrolling from MA and from which specific plans they are disenrolling. Without this information it is difficult to demonstrate when plans fail to comply with the requirements and equally challenging for policymakers to correct these actions.
