United States: CMS Releases Request For Information On Medicare Advantage Data

Key Takeaways:

• The Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) seeking data-related input from the public to improve transparency in the fast-growing Medicare Advantage (MA) market.
• CMS is soliciting input on data that could improve transparency in all aspects of the MA program, including access to care, prior authorization, supplemental benefits, and provider networks.
• Comments are due May 29, 2024.

Executive Summary

On January 30, 2024, CMS published in the Federal Register an RFI to seek input from the public regarding increased public releases of MA data to improve transparency in the program. CMS stated responses to this RFI may be used to strengthen and inform CMS' MA data capabilities and policymaking. Comments on this RFI must be received by May 29, 2024.

Background

In an RFI that appeared in the Federal Register on August 1, 2022, CMS sought feedback from the public on ways to strengthen MA so it aligns more closely with Medicare's vision and strategic pillars. CMS received more than 4,000 responses to that RFI from a variety of stakeholders. One key theme among these responses was an interest in greater beneficiary protections, such as strengthened MA marketing regulations and prior authorization protections. Respondents also asked for greater transparency and clarity in areas such as risk adjustment, value-based payment arrangements, and supplemental benefits. CMS subsequently finalized policies to improve MA data capabilities that took effect in 2024, and has since proposed further such policies.

This latest RFI serves as an extension of CMS' efforts to gain better insight into the MA programs and provide the public with increased MA data transparency. CMS states its goal is to have MA data become commensurate with data available for traditional Medicare to advance transparency across the Medicare program and allow for analysis in the context of other health programs like accountable care organizations, the Marketplace, Medicaid managed care, and integrated delivery systems. The RFI comes in the wake of increased government scrutiny of the MA program as enrollment surpasses 50% of total Medicare enrollment.

RFI's Solicitation of Public Comments

CMS is soliciting comments on all aspects of data related to the MA program, including data currently collected as well as data not currently collected. CMS states that it is particularly interested in the following topics:

• Data recommendations related to beneficiary access to care including provider directories and networks, prior authorization, and utilization management;
• Denials of care and beneficiary experience with appeals processes, as well as use and reliance on algorithms;
• Cost and utilization of supplemental benefits;
• MA marketing and consumer decision-making;
• Care quality and outcomes, including value-based care arrangements and health equity;
• Healthy competition in the market, including the impact of mergers and acquisitions, high levels of enrollment concentration, and the effects of vertical integration; and
• Special populations such as individuals dually eligible for Medicare and Medicaid, individuals with end stage renal disease, and other enrollees with complex conditions.

CMS asks academic researchers and other data analysts to provide insight into how data format, fields, and content could facilitate comprehensive analyses of publicly released MA data while also leveraging existing private sector data. In this effort, CMS seeks recommendations regarding MA data collection and release methods from plans, providers, data vendors, and other stakeholders with a deep understanding of MA data. Further, CMS is soliciting comments from beneficiary advocates, healthcare providers, and other stakeholders to understand common challenges and experiences in the MA program for which limited data is currently available.

Associate Kian Azimpoor co-authored this alert.