Sens. Bill Cassidy, MD, Elizabeth Warren, Marsha Blackburn and Catherine Cortez Masto penned a Dec. 7 letter to CMS Administrator Chiquita Brooks-LaSure. The lawmakers urged the agency to require plans to submit more data on prior authorizations.
The senators asked the agency to require plans to collect more data and to make this data publicly available, including:
- Prior authorization requests, denials and appeals by service
- Reasons for prior authorization denials
- Timeliness of decisions
- Complete encounter data
- Use of supplemental benefits
The senators also asked the agency to publish some data it already collects from plans, including out-of-pocket costs, disenrollments and plan comparison data.
“Without publicly available plan-level data on prior authorization requests … regulators are unable to adequately oversee the program and legislate potential reforms,” the senators wrote.
Politico reported Nov. 24 that bipartisan scrutiny of Medicare Advantage prior authorization is increasing.
Thirty U.S. representatives sent a letter to the agency in October, urging more oversight of the use of algorithms and artificial intelligence in Medicare Advantage coverage decisions.
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