Enhancing Medicare Advantage Transparency: HHS and CMS Take New Approach

Enhancing Medicare Advantage Transparency: HHS and CMS Take New Approach

How often have you heard, when getting Medicare data, “that does not include Medicare Advantage (MA) data in that report.” 

MA, now representing over 50 percent of Medicare enrollment, is at the forefront of a push by the U.S. Department of Health and Human Services (HHS) to provide transparent data. HHS Secretary Xavier Becerra emphasized the importance of transparency in managed care plans in his recent statements, highlighting that lack of transparency deprives patients of vital information necessary for informed healthcare decisions. It also limits the ability of researchers and doctors to evaluate patient care trends and problems.

Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure asserts the Biden Administration’s commitment to improving the Medicare Advantage program. CMS has put out a Request for Information (RFI) in a step to align MA more closely with traditional Medicare, ensuring that the program meets the growing needs of enrollees.

This initiative is critical, as MA enrollment has surged; the government is expected to pay MA health insurance companies over $7 trillion in the next decade. The solicited information aims to ensure that MA plans effectively meet Medicare beneficiaries’ needs, provide timely care access, responsibly use taxpayer funds, and promote healthy market competition.

The RFI invites public input on various MA program aspects, such as access to care, prior authorization, provider directories, supplemental benefits, marketing, care quality and outcomes, value-based care, and the effects of vertical integration on payment. It also seeks suggestions on improving MA data collection and release methods. With an extended comment period of 120 days, the initiative encourages feedback from a broad spectrum of stakeholders.

Meena Seshamani, MD, PhD, CMS Deputy Administrator, stresses the importance of transparent Medicare Advantage data in driving high-quality care and competition. This RFI is a gateway for engaging all parties interested in the MA program.

What I think should be available:

  • Part B Provider Data: To include MA data in the Part B provider data files, both summaries and detail files (this would be huge).
  • Detailed Claims Data: Unlike traditional Medicare, Medicare Advantage plans are run by private insurance companies, and detailed claims data (like individual services billed) is often not as readily available to the public. This is due to proprietary concerns and privacy regulations.
  • Provider-Level Information: Specific information about healthcare providers, including their performance or billing practices, are not accessible for those participating in MA plans compared to traditional Medicare.
Participating in the RFI Process

The MA Data RFI is accessible on the Federal Register’s webpage, with comments due by May 29, 2024. This is a unique opportunity for stakeholders to contribute to shaping the future of Medicare Advantage, ensuring that it remains a robust, transparent, and competitive option for Medicare beneficiaries.

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Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

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