CMS seeks input on improving transparency in Medicare Advantage

The Centers for Medicare & Medicaid Services is seeking feedback on how to increase transparency around Medicare Advantage and improve data capabilities.

The request for information (PDF) is the latest MA-focused action the agency has taken this month. Last week, the agency finalized a rule that gives stricter limits on when insurers must respond to prior authorization requests.

Information gained from the public through the request will "ensure MA plans appropriately use taxpayer funds" as well as bolster competition, according to a release.

CMS said it is looking for input regarding all aspects of MA including provider networks, prior authorization, supplemental benefits, marketing, care quality and outcomes, value-based care arrangements and equity and vertical integration. Other areas CMS is interested in learning more is prescription drug plans, individuals dually eligible for Medicare and Medicaid, people with end stage renal disease (ESRD) and MA marketing practices.

“The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions," said HHS Secretary Xavier Becerra in a statemnet. "It deprives researchers and doctors of critical data to evaluate problems and trends in patient care."

An extended comment period for the RFI will last 120 days. Comments are due May 29. It is the latest action addressing MA data by CMS.

In May 2022, CMS finalized a rule that added 18 supplemetal benefit reporting categories and instituted more detailed medical loss ratio reporting requirements.

By 2025, CMS should have more data to answer policy questions surrounding supplemental benefits. It is ensuring it receives more data about the MA Value-Based Insurance Design Model, a model that looks more cloely at health equity and care coordination.

The agency has also been collecting more data on race and ethnicity through voluntary MA and Part D enrollment forms and calculating risk scores using MA encounter data and traditional Medicare claims for the 2022 coverage year, according to a press release.