Staff Contact: Jane Drummond and Andrew Wheeler
CMS released a request for information to solicit feedback about how best to enhance Medicare Advantage data capabilities and increase transparency about MA activities. CMS specifically is interested in the following.
- data-related recommendations related to beneficiary access to care, including provider directories and networks
- prior authorization and utilization management, including denials of care and beneficiary experience with appeals processes, as well as use and reliance on algorithms
- cost and utilization of different supplemental benefits
- all aspects of 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, data topics related to MA prescription drug plans
- special populations, such as individuals dually eligible for Medicare and Medicaid with end-stage renal disease, and other enrollees with complex conditions
Responses to the RFI will be due 120 days after the date of publication in the Federal Register.
