The Medical Group Management Association said that as the number of Medicare Advantage beneficiaries continues to grow, "it is imperative that the MA program ensures adequate and transparent coverage to patients, timely payment to medical groups and remains a viable pathway for medical groups to participate in value-based payment arrangements."
"These priorities cannot be achieved without accurate and robust data on MA utilization management practices including prior authorization, onerous care denials and value-based contracts," MGMA said ini a May 29 letter to CMS.
MGMA's comments were in response to a request for information CMS released in January, seeking feedback on how to best enhance MA data capabilities and increase public transparency. Comments were due May 29.
In its letter, MGMA said CMS should collect more granular data on the use of prior authorization in MA. The organization said the Interoperability and Prior Authorization Final Rule requires MA plans to post aggregate metrics about prior authorization on their website. MGMA wants CMS to require this data be "publicly accessible and categorized by item and service, in a central location on the CMS website to enable patients, providers, and researchers to easily compare MA plan prior authorization data."
MGMA also said CMS could expand on existing prior authorization data reporting requirements by collecting additional data from MA plans as outlined in the proposed Improving Seniors’ Timely Access to Care Act. The legislation passed the House in 2022, but stalled in the Senate.
The organization also wants CMS to collect more robust information from MA plans about the application of value-based arrangements, such as the frequency of incorporation of value to payment methodologies and the successes of such arrangements across provider types.
MGMA also wants CMS to require MA plans to share data files relevant to managing risk for attributed patient populations in a readable format and timely manner. The group also said MA plans should be required to share all components of the net cost for Part D with at-risk providers in a timely manner.
The group also said MA plans should be required to share all costs associated with supplemental benefits with at-risk providers to "ensure providers understand whether they are being held accountable for care they have little or no control over."
Read the full letter here.