What’s happening: On June 30, CHA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in support of data collection and audit proposals that would increase Medicare Advantage Organization (MAO) transparency and accountability, ensuring appropriate and timely access to Medicare services.
What else to know: CHA supports CMS’ proposed collection of more granular data on MAO decision-making around requests for coverage and plan procedures, noting that it will help “protect Medicare beneficiaries from inappropriate delays and denials of Medicare-covered services.”
CHA highlights five specific areas of concern that warrant the greatest attention and scrutiny:
- MAO use of internal coverage criteria
- Hospital inpatient admissions and compliance with the two-midnight benchmark
- Post-acute care access
- Use of automated utilization management tools
- Oversight of third-party vendors
CHA also recommends that CMS design data collection elements to minimize administrative burden on the health care delivery system and ensure that required reporting is both meaningful and actionable.
