HHS Seeks Stakeholder Input to Improve Medicare Advantage Transparency

HHS has issued a request for information (RFI) to help improve data-sharing and transparency in the Medicare Advantage.

Over half of all Medicare beneficiaries are enrolled in Medicare Advantage, strengthening the importance of transparency in the program. Additionally, the government is expected to pay Medicare Advantage plans more than $7 trillion over the next decade, according to the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE).

“Americans with Medicare who have managed care plans called Medicare Advantage should not feel like their health care is a black box,” HHS Secretary Xavier Becerra said in the press release.

“The lack of transparency in Medicare Advantage managed care plans deprives patients of important information that helps them make informed decisions. It deprives researchers and doctors of critical data to evaluate problems and trends in patient care. Transparency is key to the Biden-Harris Administration’s effort to increase competitiveness and ensure that Medicare dollars are spent on first-rate health care.”

HHS and CMS are looking to gather information from stakeholders about care access, provider networks, prior authorization, supplemental benefits, value-based care arrangements, health equity, marketing, and care quality.

In addition, the RFI seeks feedback on healthy competition in the Medicare Advantage market, the effects of vertical integration, and how to improve data collection and release methods.

“In health care, you can’t improve what you don’t know, and the way to know is with data. We need to have transparent Medicare Advantage data to see what’s working and what’s not working to inform our efforts to protect enrollees and drive high-quality care and competition,” Meena Seshamani, MD, PhD, CMS Deputy Administrator and Director of the Center for Medicare said. “Through this RFI, we look forward to engaging all parties interested in the Medicare Advantage program.”

The comment period for the RFI is 120 days to encourage feedback from stakeholders across the entire healthcare industry.

The RFI builds on previous efforts to improve Medicare Advantage data and transparency. For example, in 2022, CMS finalized rulemaking to add 18 supplemental benefit reporting categories and to reinstate detailed medical loss ratio (MLR) reporting requirements.

Additionally, the agency recently finalized prior authorization and interoperability policies requiring Medicare Advantage plans to publicly report data on prior authorization denials and approvals. The rule also shortens the prior authorization decision time to 72 hours for urgent requests and seven calendar days for standard requests.