Notice2024-01832
Medicare Program; Request for Information on Medicare Advantage Data
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
January 30, 2024
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This request for information (RFI) seeks input from the public regarding various aspects of Medicare Advantage (MA) data. Responses to this RFI may be used to inform general efforts to strengthen Centers for Medicare & Medicaid Services' (CMS') MA data capabilities and guide policymaking.
Full Text
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<title>Federal Register, Volume 89 Issue 20 (Tuesday, January 30, 2024)</title>
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[Federal Register Volume 89, Number 20 (Tuesday, January 30, 2024)]
[Notices]
[Pages 5907-5909]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-01832]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4207-NC]
RIN 0938-ZB84
Medicare Program; Request for Information on Medicare Advantage
Data
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Request for information.
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SUMMARY: This request for information (RFI) seeks input from the public
regarding various aspects of Medicare Advantage (MA) data. Responses to
this RFI may be used to inform general efforts to strengthen Centers
for Medicare & Medicaid Services' (CMS') MA data capabilities and guide
policymaking.
DATES: To be assured consideration, comments must be received at one of
the addresses provided below, by May 29, 2024.
ADDRESSES: In commenting, refer to file code CMS-4207-NC.
Comments, including mass comment submissions, must be submitted in
one of the following three ways (please choose only one of the ways
listed):
1. Electronically. You may submit electronic comments on this
document to <a href="http://www.regulations.gov">http://www.regulations.gov</a>. Follow the ``Submit a comment''
instructions.
2. By regular mail. You may mail written comments to the following
address ONLY: Centers for Medicare & Medicaid Services, Department of
Health and Human Services, Attention: CMS-4207-NC, P.O. Box 8013,
Baltimore, MD 21244-8013.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments to
the following address ONLY: Centers for Medicare & Medicaid Services,
Department of Health and Human Services, Attention: CMS-4207-NC, Mail
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT: Ilina Chaudhuri, (410) 786-8628.
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following
website as soon as possible after they have been received: <a href="http://www.regulations.gov">http://www.regulations.gov</a>. Follow the search instructions on that website to
view public comments. CMS will not post on <a href="http://Regulations.gov">Regulations.gov</a> public
comments that make threats to individuals or institutions or suggest
that the individual will take actions to harm the individual. CMS
continues to encourage individuals not to submit duplicative comments.
We will post acceptable comments from multiple unique commenters even
if the content is identical or nearly identical to other comments.
I. Background
In a request for information that appeared in the Federal Register
on August 1, 2022 (87 FR 46918) (hereinafter referred to as 2022
General MA RFI), CMS sought feedback on ways to strengthen Medicare
Advantage (MA) to align with the Vision for Medicare (<a href="https://www.cms.gov/blog/building-cms-strategic-vision-working-together-stronger-medicare">https://www.cms.gov/blog/building-cms-strategic-vision-working-together-stronger-medicare</a>) and the CMS Strategic Pillars (<a href="https://www.cms.gov/about-cms/what-we-do/cms-strategic-plan">https://www.cms.gov/about-cms/what-we-do/cms-strategic-plan</a>). The 2022 General MA RFI set
out to create more opportunities for stakeholders to engage with CMS,
and in alignment with the agency's Strategic Pillars, prioritize
increased engagement throughout the policy process with our partners
and the communities we serve. As a result of this commitment, we
received more than 4,000 responses from a wide variety of voices. One
key theme that emerged was an interest in greater beneficiary
protections, such as strengthened MA marketing regulations and prior
authorization protections. Respondents also focused on issues related
to payment, including accurate risk adjustment and value-based payment
arrangements between providers and insurers, as well as competition in
the market, such as topics related to insurer consolidation and
vertical integration. Additionally, we received strong feedback from
respondents who stated that CMS should have comprehensive high-quality
MA programmatic data and promote more program transparency through
increased public releases of MA data. Respondents underscored the
urgency for more complete MA data and data transparency as enrollment
in MA
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has for the first time reached half of all people enrolled in
Medicare.\1\
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\1\ From ``Medicare Advantage and Medicare Prescription Drug
Programs to Remain Stable in 2024'', available at <a href="https://www.cms.gov/newsroom/press-releases/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-2024">https://www.cms.gov/newsroom/press-releases/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-2024</a>.
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Recommendations regarding MA data included calls for CMS to collect
and release more MA data on key areas of concern, such as supplemental
benefit costs and utilization, value-based payment arrangements between
providers and plans, utilization management and prior authorization
including denials and appeals and access to inpatient services and
post-acute care, network adequacy and provider directory accuracy,
competitive forces in the market such as the effects of market shifts
and vertical integration and consolidation on consumers, care outcomes,
and Medicare Loss Ratios (MLRs). Commenters also raised data
considerations on topics such as MA marketing activity, especially
predatory behavior, care outcomes and data available in MA compared to
Traditional Medicare (Medicare Parts A and B), and geographic impacts
including on rural areas, among other important topic areas.
Respondents emphasized that CMS should improve its data capabilities to
measure impacts of MA on underserved communities. HHS' Office of
Inspector General (OIG), the Government Accountability Office (GAO),
and the Medicare Payment Advisory Commission (MedPAC) have pointed out
program areas that would benefit from better or more MA data as
well.\2\
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\2\ Examples of such studies and reports include: ``Priority
Open Recommendations: Department of Health and Human Services.'' May
2023. <a href="https://www.gao.gov/assets/gao-23-106467.pdf">https://www.gao.gov/assets/gao-23-106467.pdf</a>; ``The Inability
To Identify Denied Claims in Medicare Advantage Hinders Fraud
Oversight.'' OEI-03-21-00380. March 2023. <a href="https://oig.hhs.gov/oei/reports/OEI-03-21-00380.asp">https://oig.hhs.gov/oei/reports/OEI-03-21-00380.asp</a>; ``Medicare Advantage: Plans Generally
Offered Some Supplemental Benefits, but CMS Has Limited Data on
Utilization.'' Jan 2023. <a href="https://www.gao.gov/products/gao-23-105527">https://www.gao.gov/products/gao-23-105527</a>;
``OIG's Top Unimplemented Recommendations: Solutions to Reduce
Fraud, Waste, and Abuse in HHS Programs.'' 2022. <a href="https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2022.pdf">https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2022.pdf</a>; ``CMS Generally Ensured That Medicare Part C and
Part D Sponsors Did Not Pay Ineligible Providers for Services to
Medicare Beneficiaries.'' A-02-20-01027. Oct 2022. <a href="https://oig.hhs.gov/oas/reports/region2/22001027.pdf">https://oig.hhs.gov/oas/reports/region2/22001027.pdf</a>; ``Some Medicare
Advantage Organization Denials of Prior Authorization Requests Raise
Concerns About Beneficiary Access to Medically Necessary Care.''
OEI-09-18-00260. Apr 2022. <a href="https://oig.hhs.gov/oei/reports/oei-09-18-00260.asp">https://oig.hhs.gov/oei/reports/oei-09-18-00260.asp</a>; ``Medicare Advantage Organizations Are Missing
Opportunities To Use Ordering Provider Identifiers to Protect
Integrity.'' OEI Report OEI-03-19-00432. Apr 2021. <a href="https://oig.hhs.gov/oei/reports/OEI-03-19-00432.asp">https://oig.hhs.gov/oei/reports/OEI-03-19-00432.asp</a>; <a href="https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/jun19_ch7_medpac_reporttocongress_sec.pdf">https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/jun19_ch7_medpac_reporttocongress_sec.pdf</a>; ``The Inability
To Identify Denied Claims in Medicare Advantage Hinders Fraud
Oversight.'' (OEI-03-21-00380) March 2023. <a href="https://oig.hhs.gov/oei/reports/OEI-03-21-00380.asp">https://oig.hhs.gov/oei/reports/OEI-03-21-00380.asp</a>.
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During the Biden-Harris Administration, we have finalized policies
for 2024 \3\ and proposed policies \4\ that will improve MA data
capabilities, among other important MA policy changes. We have also
issued requirements for collecting more data related to supplemental
benefits in the updated Part C reporting requirements,\5\ required MA
organizations to improve prior authorization processes \6\ and final
interoperability requirements,\7\ and begun collecting race and
ethnicity data on a voluntary basis on MA and Part D enrollment
forms.\8\
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\3\ <a href="https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f">https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f</a>.
\4\ <a href="https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare">https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare</a>; <a href="https://www.cms.gov/newsroom/fact-sheets/contract-year-2024-policy-and-technical-changes-medicare-advantage-and-medicare-prescription-drug">https://www.cms.gov/newsroom/fact-sheets/contract-year-2024-policy-and-technical-changes-medicare-advantage-and-medicare-prescription-drug</a>.
\5\ <a href="https://www.cms.gov/medicare/enrollment-renewal/health-plans/part-c">https://www.cms.gov/medicare/enrollment-renewal/health-plans/part-c</a>.
\6\ <a href="https://www.cms.gov/newsroom/fact-sheets/contract-year-2024-policy-and-technical-changes-medicare-advantage-and-medicare-prescription-drug">https://www.cms.gov/newsroom/fact-sheets/contract-year-2024-policy-and-technical-changes-medicare-advantage-and-medicare-prescription-drug</a>; <a href="https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare">https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare</a>.
\7\ <a href="https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f">https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f</a>.
\8\ <a href="https://www.cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10718">https://www.cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10718</a>.
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This RFI is an extension of our ongoing work on MA data as we
solicit feedback from the public on how best to meet the shared goals
of enhancing data capabilities to have better insight into our
programs, consider areas to increase MA data transparency, and propose
future rulemaking. Our eventual goal is to have, and make publicly
available, MA data commensurate with data available for Traditional
Medicare to advance transparency across the Medicare program, and to
allow for analysis in the context of other health programs like
accountable care organizations, the Marketplace, Medicaid managed care,
integrated delivery systems, among others.
II. Solicitation of Public Comments
We encourage feedback from a wide array of interested parties,
including beneficiaries and beneficiary advocates, plans, providers,
community-based organizations, researchers, employers and unions, and
all other interested parties, including the public at large. Our
interest in this RFI is to solicit comments on all aspects of data
related to the MA program. Intimate knowledge of CMS' current data
availability or capability is not needed to provide input on the
aspects of MA for which commenters think policymakers and the public
should have more data.
In this RFI, CMS requests comments on all aspects of data related
to the MA program--both data not currently collected as well as data
currently collected. We are especially interested in: data-related
recommendations related to 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 Medicare Advantage
prescription drug plans (MAPDs); and special populations such as
individuals dually eligible for Medicare and Medicaid, individuals with
end stage renal disease (ESRD), and other enrollees with complex
conditions. We ask that academic researchers and other data analysts
provide precise detail and definitions on the data format, fields, and
content that would facilitate comprehensive analyses of any publicly
released MA data, including comparisons with existing data sets, for
example, between Traditional Medicare and MA. Additionally, we seek
detail regarding the rationale, goals, and questions that you could
address with newly released data and suggestions for how such data
could support new action or regulation by CMS. We are also interested
to hear if you have insight in ways in which CMS could leverage
existing private sector data.
It would also be helpful for plans, providers, data vendors, and
other stakeholders with a deep understanding of MA data to provide
recommendations related to operational considerations as part of this
effort. Comments are welcome on ways that we could improve our current
MA data collection and release methods, including recommendations on
the preferred cadence of data releases. Finally, we seek detailed
information from beneficiary advocates, health care providers, and
other stakeholders on common challenges and experiences in
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the MA program for which limited data are currently available.
III. Collection of Information Requirements
This is a request for information (RFI) only. In accordance with
the implementing regulations of the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501 et seq.), specifically 5 CFR 1320.3(h)(4), this
general solicitation is exempt from the PRA. Facts or opinions
submitted in response to general solicitations of comments from the
public, published in the Federal Register or other publications,
regardless of the form or format thereof, provided that no person is
required to supply specific information pertaining to the commenter,
other than that necessary for self-identification, as a condition of
the agency's full consideration, are not generally considered
information collections and therefore not subject to the PRA.
This RFI is issued solely for information and planning purposes; it
does not constitute a Request for Proposal (RFP), applications,
proposal abstracts, or quotations. This RFI does not commit the U.S.
Government to contract for any supplies or services or make a grant
award. Further, we are not seeking proposals through this RFI and will
not accept unsolicited proposals. Responders are advised that the U.S.
Government will not pay for any information or administrative costs
incurred in response to this RFI; all costs associated with responding
to this RFI will be solely at the interested party's expense. In
addition, this RFI does not commit the Government to any policy
decision and CMS will follow established methods for proposing future
policy changes, including the MA Advance Notice and Rate Announcement
process. We note that not responding to this RFI does not preclude
participation in any future procurement or rulemaking, if conducted. It
is the responsibility of the potential responders to monitor this RFI
announcement for additional information pertaining to this request. In
addition, we note that CMS will not respond to questions about the
policy issues raised in this RFI.
Chiquita Brooks-LaSure, Administrator of the Centers for Medicare &
Medicaid Services, approved this document on January 22, 2024.
Dated: January 25, 2024.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2024-01832 Filed 1-25-24; 4:15 pm]
BILLING CODE 4120-01-P
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</html>Indexed from Federal Register on January 30, 2024.
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