Last week saw four Senators urging the Centers for Medicare and Medicaid Services (CMS) to enhance data collection and publishing in relation to Medicare Advantage (MA) plans, in order to allow better scrutiny of the practices of these plans, which includes prior authorization practices. The impetus behind this request was increased scrutiny of said plans.
The bipartisan group of senators comprises Elizabeth Warren (D-Massachusetts), Catherine Cortez Masto (D-Nevada), Bill Cassidy (R-Louisiana), and Marsha Blackburn (R-Tennessee). Their letter addressed CMS Administrator Chiquita Brooks-LaSure, highlighting several statistics that raise questions about MA practices.
For example, in 2019, according to the Office of the Inspector General, only 13% of MA prior authorization denials and 18% of MA payment denials met Medicare coverage rules, suggesting that MA plans may have delayed or denied seniors access to services which under traditional Medicare were likely to have been approved. Furthermore, researchers have found that CMS gave MA plans $106 billion in excess payments between 2010 and 2019, with MA plans expected to receive $27 billion in overpayments in 2023 alone.
The group of senators, in their letter to CMS, requested collection and publication of data on prior authorization requests, denials, and appeals by type of service. Additionally, the senators would like to see the release of CMS-collected data on out-of-pocket costs and provider payments. They have also called for increased elucidation on reasons behind prior authorization denials and the timeline for prior authorization request completion.
Greater transparency was also sought in relation to the reasons why seniors choose to leave MA and enrol in traditional Medicare, as well as the advocates for a better comparison of quality and performance between MA and traditional Medicare. They have asked CMS to provide a briefing on how it plans to improve its MA data collection and reporting practices by December 27.