CMS Requests Public Comment on Medicare Advantage

Last week, the Centers for Medicare and Medicaid Services (CMS) released a Request for Information (RFI), seeking comment on ways to improve Medicare Advantage and make the program more equitable, affordable and sustainable.

Medicare Advantage (MA) has been under great scrutiny lately, for policies on prior authorization, the adequacy of quality metrics for the program, the seemingly widespread fraudulent misuse of risk assessments and a general lack of oversight. In a short headline post announcing the CMS ROI, the American Hospital Association (AHA) included a reminder of its position on MA plans:

AHA has urged CMS and Congress to hold Medicare Advantage plans accountable for inappropriately and illegally restricting beneficiary access to medically necessary care.

Medicare Advantage is currently poised to eclipse over 50% of the Medicare total market by next year, and has proven to be very popular with consumers. But according to Healthcare Finance, while premiums are lower and often free, many beneficiaries end up paying more over time — as they age, their need for care becomes more acute and subsequently more costly out of pocket.

Furthermore, a survey published in June by eHealth found that 13% of Medicare beneficiaries had a claim or pre-authorization request denied and a Report by the Office of Inspector General covered by The Hertel Report found that Medicare Advantage Organizations (MAOs) sometimes delay or deny access to necessary services, even though the prior authorization requests met Medicare coverage rules.

CMS Administrator Chiquita Brooks-LaSure said that the request is part of the Biden administration’s rigorous pursuit of improving American health care.

Medicare Advantage is a critical part of CMS’ vision to advance health equity; expand access to affordable coverage and care; drive high-quality, person-centered care; and promote affordability and sustainability of Medicare. Medicare Advantage plans are essential partners in this work.

Inside Health Policy says that CMS is looking to find out how the growth of MA will affect Medicare overall and how beneficiaries in underserved populations can have their needs better met by MAOs. Additionally, they’re looking for feedback on how plans’ marketing informs beneficiaries about the details of specific plans and how CMS and the plans can make sure that plan choices are more broadly understood by beneficiaries.

Other areas the agency is looking for feedback on include: telehealth, network adequacy, behavioral health services, prior authorization policies, supplemental benefits, markets and competition and overall health equity.

The full RFI can be found at the Federal Register.