CMS looks to tackle Medicare Advantage's 'black box'

CMS is seeking input on improving transparency in the Medicare Advantage program. 

The agency issued a request for information Jan. 25, seeking public feedback on how data collection and transparency in the program can be improved. 

In a news release, HHS Secretary Xavier Becerra said increased transparency is key to increasing competitiveness in the program and ensuring Medicare dollars are spent correctly. 

"Americans with Medicare who have managed care plans called Medicare Advantage should not feel like their health care is a black box," Mr. Becerra said. "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." 

According to the news release, the agency is seeking feedback on data collection in all aspects of the program, including prior authorization, provider networks and directories, supplemental benefit use, quality and outcomes, and the effect of vertical integration. The agency is also seeking comments on improving its data collection and release methods. 

Some researchers and advocates have said a lack of publicly available data leaves unanswered questions about Medicare Advantage. 

A 2023 report from the Government Accountability Office found CMS is lacking data on the use of supplemental benefits in Medicare Advantage and recommended the agency implement clearer standards for what plans must submit to the government. 

CMS will require plans to publicly report certain prior authorization metrics beginning in 2026. 

The request for information is open until May 29.

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