Dive Brief:
- * The CMS is asking for public feedback on how to make the Medicare Advantage program more affordable, sustainable and equitable for enrollees, while driving better health outcomes. The agency on Friday published a request for information to aid in future rulemaking and policy development.
- * The request for public input comes after the HHS Office of Inspector General identified a pattern of improper coverage denials by Medicare Advantage plans, and the American Hospital Association accused MA plans of illegally restricting beneficiaries’ access to medically necessary care. The AHA has urged the CMS and Congress to hold the plans accountable.
- * The CMS said it is looking to increase engagement with both its partners and the communities it serves, encouraging input from beneficiary advocates, plans, providers, community organizations, researchers, employers, unions and others.
Dive Insight:
Seniors have flocked to Medicare Advantage plans over the past decade, attracted by affordable premiums, prescription drug coverage, add-on benefits such as dental and vision, and other features. The plans’ popularity has pushed overall program enrollment to 29 million participants, or 45% of all Medicare members. Medicare pays private insurers fixed rates to manage care for beneficiaries in the program.
But along with the plans’ success have come accusations of improper payments and care denials. Lawmakers in both the Senate and House have called for increased oversight of the program, raising concerns about the quality of coverage offered by Medicare Advantage plans and unscrupulous practices to boost reimbursement for MA organizations.
The HHS’ OIG issued a report in April that found Medicare Advantage plans wrongly denied care to enrollees, turning down 13% of prior authorization requests that would have been approved under traditional Medicare. The plans also denied 18% of payment requests that should have been approved.
The OIG report urged the CMS to update its audit protocols and issue new guidance on medical necessity reviews performed by the plans. Researchers have also warned that the program is a key driver of Medicare’s overall fiscal woes.
In its request for information from the public, the CMS said it is inviting input from a wide variety of voices. “We see a huge opportunity for partnership with as many stakeholders as possible to better understand how care innovations are changing outcomes and costs and how Medicare Advantage is working for enrollees,” Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, said in a statement.
The CMS asked for feedback on steps the agency can take to improve health equity for all MA enrollees and what tools beneficiaries need to select Medicare coverage options. The agency is also seeking input on how to support payment innovation, accountable care delivery and effective competition in the Medicare Advantage market.
The CMS said comments from the public must be received by the agency by Aug. 31.