CMS releases data RFI to improve data sharing and increase competition
On December 7th, the Biden-Harris administration Announcement of new initiatives Promote competition in health care, including increasing transparency in the Medicare Advantage (MA) insurance market and strengthening MA program data. Now, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), continues its momentum in this area by publishing a Request for Information (RFI) seeking feedback from the public on best practices. To strengthen MA data capabilities and increase public transparency. Transparency is especially important now that MA has grown to over 50% of Medicare enrollees and the government is expected to pay the excess amount to MA health insurers. 7 trillion dollars Over the next 10 years. The information solicited by this RFI will help ensure that MA plans best meet the needs of Medicare enrollees, ensure that Medicare enrollees have timely access to care, and ensure that MA plans use taxpayer funds appropriately. and support efforts to enable markets to provide sound medical care. competition.
“Americans with Medicare, who manage a care plan called Medicare Advantage, should not feel like their health care is a black box,” said Health Department Secretary Xavier Becerra. “The lack of transparency in care plans managed by Medicare Advantage deprives patients of critical information that helps them make informed decisions. It deprives us of critical data to assess trends. Transparency is key to the Biden-Harris Administration's efforts to increase competitiveness and ensure Medicare dollars are spent on top-notch care.”
“The Biden-Harris administration is committed to improving the Medicare Advantage program,” said CMS Administrator Chiquita Brooks LaSure. “This request for information is designed to further strengthen our collaboration with traditional Medicare and provide the data needed to ensure that the growing Medicare Advantage program best meets the needs of our enrollees. ’s Medicare Advantage Data Transparency Initiative.”
CMS has already taken several steps to improve transparency in this market, as outlined below, and the MA Data RFI is the next step in these efforts. CMS is seeking data-related input from the public related to all aspects of the MA program, including access to care, prior authorization, provider directories, and networks. Additional benefits. Marketing; Quality of Care and Outcomes. Value-based care arrangements and equity. Healthy competition in the market, including the effects of vertical integration and how it affects payments. We also seek comments on improvements to how MA data is collected and published. The RFI extends the comment period to 120 days to encourage feedback from a broader range of stakeholders and to allow time for meetings and other efforts to compile detailed feedback to CMS.
“In health care, you can't improve what you don't know, and the way to know is through data. We need to understand what works to inform our efforts to protect enrollees and promote quality care and competition. We need transparent Medicare Advantage data to understand what isn't working,” said Meena Seshamani, MD, CMS Deputy Administrator and Center Director. Medicare. “We look forward to engaging with all interested parties in the Medicare Advantage program through this RFI.”
Background on working with existing CMS MA data
Today's announcement builds on CMS's existing MA data transparency efforts to improve data capabilities. CMS has already made changes to the MA, including more comprehensive payment data related to medical loss ratios (MLR), new data streams on supplemental benefit cost and utilization, and new data collection and public posting requirements related to prior authorization. We are starting to collect further data related to various aspects. New collection of racial and ethnic data. CMS also has increased requirements for the integrity of encounter data.
For MLR data, CMS finalized rulemaking in May 20221 Adds 18 supplemental benefit reporting categories and reinstates detailed MLR reporting requirements previously in effect for contract years 2014-2017. This requirement requires reporting of the underlying data used to calculate and verify the MLR and the amount of remittances incurred. claims, gross revenue, expenditures on quality improvement activities, non-claims expenses, taxes, and regulatory fees.
With respect to supplemental benefits, CMS is taking several steps to ensure that by 2025, changes related to supplemental benefits, including what they offer, which plans they spend on, which enrollees use which services, and their cost. Ensure that CMS has the data it needs to answer important policy questions. Offers to Subscribers and Plan Level Availability.2 CMS conducted a technical assistance call to assist with plans to report encounter data for supplemental benefits, including special supplemental benefits for the chronically ill. CMS is also collecting additional data related to the MA value-based insurance design model.3 This explores how MA plans can more comprehensively address patients' medical and health-related social needs, promote health equity, and improve coordination of care for patients with serious illnesses. It's something to test.
Regarding utilization management and access to care, CMS recently finalized requirements for prior authorization and interoperability, requiring MA organizations to publicly report data on prior authorization denials and approvals.Four and a proposed requirement for MA plans to publicly publish an annual health equity analysis of their prior authorization policies and procedures.Five
Regarding race and ethnicity data, CMS began voluntarily collecting race and ethnicity data on MA and Part D enrollment forms.6 CMS also requires and encourages more complete and accurate reporting of encounter data by MA organizations. In addition to the encounter data efforts related to the supplemental benefits detailed above, over time, CMS will progressively expand the use of encounter data in risk score calculations, eventually replacing the previous risk adjustment. processing system (RAP) to calculate 100% of the risk score. Risk score using MA encounter data and diagnoses from traditional Medicare claims for the 2022 coverage year.
The MA data RFI includes: Federal Register web page of https://www.federalregister.gov/public-inspection/current. Comments are due by his May 29, 2024 date.
Endnotes
1 “Medicare Program, 2023 Contract Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs,” Federal Register, Volume 87, Issue 89, May 9, 2022. https://www.govinfo.gov/content/pkg/FR-2022-05-09/pdf/2022-09375.pdf. Preamble discussion of MLR reporting requirements begins on page 27825.
2 CMS has enhanced MLR reporting data requirements to collect more detailed information on spending on 18 categories of supplemental benefits (first collection for the 2023 plan year in December 2024). Established new Part C (Medicare Advantage) reporting requirements to collect plan-level data on supplemental benefit cost and utilization (plan data collection begins in January 2024, with first submission in February 2025). Month). https://www.cms.gov/medicare/enrollment-renewal/health-plans/part-c.
3 https://www.cms.gov/files/document/vbid-cy25-rfa.pdf
Four https://www.cms.gov/newsroom/press-releases/cms-finalizes-rule-expand-access-health-information-and-improve-prior-authorization-process
Five https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare
6 https://www.cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10718
