Building on prior requests for information and an increased focus on Medicare Advantage oversight, the Centers for Medicare and Medicaid Services (CMS) has issued another request for information (RFI) seeking input on data needed for Medicare Part C, also known as the Medicare Advantage (MA) program. The goal of this RFI, which was published in the Federal Register on January 30, 2024, is to provide CMS with feedback on both the format and types of data that will allow CMS to have better insight into MA organizations and their operations and to consider future rulemaking. Responses to the RFI are due by May 29, 2024.
This RFI is an extension of CMS’s General MA RFI published in August 2022, which generated over 4,000 responses from various stakeholders. The 2024 RFI broadly seeks input on “all aspects of data related to the MA program—both data not currently collected as well as data currently collected.” The eventual goal is to make MA data commensurate with data available from Medicare Parts A and B to ensure appropriate transparency into MA organizations and to address perceived shortcomings through additional rulemaking.
Here is a list of the example areas that CMS is considering increasing its data collection and release for MA organizations, and for which CMS specifically encourages RFI responses:
- 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 (MAPDs);
- special populations such as individuals dually eligible for Medicare and Medicaid;
- individuals with end stage renal disease (ESRD), and other enrollees with complex conditions.
In its RFI, CMS has asked academic researchers and other data analysts to provide precise detail and definitions on the data format, fields, and content as well as a listing of the rationale, goals or questions that could be addressed by the new data. CMS also encourages non-MA organizations, lawyers, and others not familiar with data or interoperability requirements to provide input on the information that may be helpful for CMS to access for MA. Additionally, building on interoperability rule requirements, CMS is also interested in input from plans, providers, and data vendors about the operational aspects of collecting, reviewing, and releasing this data.
Reed Smith will continue to follow developments related to this RFI and the future rulemaking that follows. For more information, or with assistance in preparing a response to the RFI, please contact the authors or a member of the Reed Smith health care team.