What’s happening: The Centers for Medicare & Medicaid Services (CMS) has issued detailed information about data collection and audit procedures for Medicare Advantage (MA) (Part C) plans.
What else to know: The information will allow CMS to conduct a comprehensive review of plan compliance with utilization management requirements, including new requirements on development, appropriateness, and public accessibility of internal coverage criteria.
CHA has consistently advocated for greater oversight of MA plans by CMS to ensure beneficiary access to medically necessary services. Additional information is available at CMS-10913.
