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On January 25, the Centers for Medicare and Medicaid Services (CMS) issued a request for information (RFI) on how to increase transparency and improve the data capabilities of Medicare-managed care plans. Comments on the RFI are due to CMS by mid-summer.

 In issuing the RFI, CMS noted that private Medicare Advantage (MA) plans cover more than half of Medicare’s beneficiaries and are projected to receive more than $7 trillion in federal funding over the next ten years. The RFI is aimed at gathering input on how to best manage both the operation of MA plans and their cost. Specifically, the RFI asks for information on:

  • Access to care
  • Prior authorization
  • Provider directories
  • Provider networks
  • Supplemental benefits
  • Marketing
  • Care quality and outcomes
  • Value-based care arrangements and equity
  • Healthy competition in the marketplace

“In health care, 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,” Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, said in a statement.

Prospects: The CMS RFI is at least in part driven by Congressional concern. A bipartisan group of Senators (including Sens. Bill Cassidy (R-LA), Elizabeth Warren (D-MA), Marsha Blackburn (R-TN), and Catherine Cortez Masto (D-NV)) have been encouraging CMS to improve MA plan data collection and reporting practices. Thus, this RFI is likely a precursor to MA rules change proposals after comments have been collected and analyzed and conclusions are reached.

NAIFA Staff Contact: Michael Hedge – Senior Director – Government Relations, at mhedge@naifa.org.