What’s happening: In a Nov. 12 letter to the Centers for Medicare & Medicaid Services (CMS), CHA conveyed its strong support for proposed implementation of additional data collection and audit procedures for Medicare Advantage (MA) plans’ utilization management policies and tools — and shared additional comments.
What else to know: CHA has consistently advocated for greater oversight of MA plans by CMS to ensure beneficiary access to medically necessary services.
In that vein, CHA’s letter also:
- Encourages CMS to expand its proposed data collection to include measures that will assess MA organizations’ use of prior authorization and its impact on patient access
- Requests the collection of data related to the utilization of certain service categories to ensure that MA plans provide their enrollees with the appropriate level of care in the appropriate setting
- Asks CMS to ensure that its data collection captures information on how plans use artificial intelligence and other predictive technologies to make prior authorization determinations
