ARTICLE SUMMARY:
MDMA calls for more disclosure from Medicare Advantage plans. Excerpted from Pathways’ Picks June 5: EU Elections, Medicare Picks, Lab Lawsuit, and More.
Medicare Advantage plans should be required to disclose, to CMS and to the public, more details about their prior authorization, coverage, and payment policies, the Medical Device Manufacturers Association argued in a May 29 letter to CMS. MDMA was responding to a January 2024 request for information by the agency seeking input on “Medicare Advantage data.” The RFI comes amid multiple policy reforms that CMS has advanced over the past year for private insurers that administer MA plans, including tighter controls to ensure the plans align with traditional Medicare coverage policies and steps to improve prior authorization procedures. But MDMA says CMS should enforce more reporting requirements to ensure the plans comply with these rules. MA plans, for instance, should have to disclose more details about their prior authorization procedures, including use of AI algorithms, and to report on the “adequacy” of their networks to ensure coverage of critical therapies. The Medicare agency, the trade group says, should also collect data on MA rates paid for devices that get New Technology Add-On Payments and other types of bonus payments to ensure the plans aren’t underpaying for the technologies and receiving a windfall from Medicare.