Senators press for MA data
By HME News Staff
Updated 9:40 AM CST, Thu December 21, 2023
WASHINGTON – Sens. Marsha Blackburn, R-Tenn., Bill Cassidy, R-La., Catherine Cortez Masto, D-Nev., and Elizabeth Warren, D-Mass., have asked CMS to collect and publish more Medicare Advantage data to help lawmakers and regulators better understand the impact of these plans in a new letter to CMS Administrator Chiquita Brooks-Lasure.
AAHomecare stated in a recent bulletin:
The senators cite “concerning trends” in Medicare Advantage and point to a 2019 HHS OIG study that “found that among requests MA plans denied, 13% of prior authorization denials and 18% of payment denials actually met Medicare coverage rules.” The letter also notes a CMS estimate that MA plans have received at least $106 billion in excess payments between 2010 and 2019, as well as a MedPAC forecast of a possible $27 billion in overpayments for 2023, according to a bulletin from AAHomecare.
The senators seek data that includes:
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Prior authorization requests, denials and appeals by type of service.
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Justification of prior authorization denials.
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Timeliness of prior authorization decisions.
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Out-of-pocket costs and provider payment information.
“CMS can collect and publish these data using its existing authority,” the letters states. “To strengthen the transparency of MA plans and improve care for Medicare beneficiaries, we urge CMS to take these actions. We also respectfully request that you provide us with a staff-level briefing on CMS’s plan to improve its data collection and reporting practices for MA plans by Dec. 27, 2023.”
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