Medicare Program; Request for Information on Medicare Advantage Data

CMS

This request for information (RFI) seeks input from the public regarding various aspects of Medicare Advantage (MA) data. Responses to this RFI may be used to inform general efforts to strengthen Centers for Medicare & Medicaid Services’ (CMS’) MA data capabilities and guide policymaking.

To be assured consideration, comments must be received at one of the addresses provided below, by May 29, 2024.

CLICK HERE to learn more or to comment

Colorado May Become the 3rd State to Drop its Medical Aid-in-Dying Residency Requirement

The Colorado Sun | By Jesse Paul

Senate Bill 68 would also shorten the mandatory waiting period for people seeking to end their lives to 48 hours from 15 days. Additionally, it would let advanced practice registered nurses prescribe aid-in-dying medication.

Colorado may become the third state to allow out-of-state residents to receive medical aid in dying through a bill that would also shorten the mandatory waiting period for people seeking to end their lives.

Senate Bill 68, which was introduced in the legislature on Jan. 22, would shrink the waiting period to 48 hours from 15 days and also let advanced practice registered nurses, in addition to doctors, prescribe aid-in-dying medication. 

The bill comes eight years after Colorado voters overwhelmingly approved Proposition 106, which legalized aid in dying in the state for terminally ill adults given less than six months to live and who get the approval of two doctors.

Proponents of the bill say it would remove barriers that the ballot measure unintentionally put in place. 

“There are more people who are utilizing this option for end of life,” said Sen. Joann Ginal, a Fort Collins Democrat and one of the lead sponsors of the legislation. “We just want to make sure that those people are getting the care and the medication in the best way possible so that their lives will end in a more peaceful manner in the way they want at the time they want.”

Colorado is among just 10 states that currently allow medical aid in dying. Washington, D.C., does, too. 

Oregon was the first to drop its residency requirement, in 2022. Vermont followed in May. 

There are sure to be concerns raised about so-called aid-in-dying tourism in Colorado if the measure passes. But because the changes in Oregon and Vermont are so recent, there’s a dearth of data on whether removing the residency requirement affected the use of the aid-in-dying option in those states. 

Kim Callinan, the CEO of Compassion and Choices, a group that advocates for medical aid-in-dying legislation across the country, said fears that terminally ill patients would suddenly flood to Colorado if Senate Bill 68 passes are overstated.

“A person who is terminally ill and at the very end of their life — it takes a considerable amount of effort to get up and move to another state,” she said. 

Most states where medical aid in dying is legal have a waiting period of at least 15 days between when someone asks a medical professional to sign off on the end-of-life option and when they can get the medication…

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Key Lawmakers Urge CMS to Curb Medicare Advantage Fraud, Abuse

McKnight’s Home Care | By Adam Healy
 
The Centers for Medicare & Medicaid Services should take swift action to “curb abusive practices” by Medicare Advantage plans, senators said in a letter sent Thursday. 
 
“The MA program is based on the premise that private insurance companies can and would administer Medicare coverage more cost-effectively — but it has failed to do so every single year,” Sens. Pramila Jayapal (D-WA) and Elizabeth Warren (D-MA) wrote in their letter. 
 
The Medicare Payment Advisory Commission has estimated that MA plans average receiving as much as 6% more per enrollee than traditional Medicare, the letter writers said. On top of that, MA plans also spend roughly 25% less on healthcare services per enrollee, they noted.
 
“It is imperative for CMS to rein in these abuses and protect Medicare coverage for
the seniors and people with disabilities who rely on it,” the senators wrote.
 
Jayapal and Warren recommended improvements in four areas. First, they advised CMS to augment base MA payments to offset overpayments due to favorable selection. Since MA beneficiaries are typically younger and healthier, they wrote, MA insurers may receive higher-than-average reimbursement from CMS while also paying out fewer claims, resulting in “gross overpayments.”
 
They also recommended CMS get more aggressive about recouping overpayments, implement a “network quality” measurement to MA plans’ star ratings, and limit insurers’ use of health risk assessments — which have been criticized for their lack of transparency.
 
Jayapal and Warren also noted MA plans’ use of artificial intelligence to “systematically deny care.” In November, UnitedHealthcare, the largest MA insurer, was alleged in a class action lawsuit to have used artificial intelligence tools to deny hundreds of patients post-acute care services, including home health.
 
Also on Thursday, CMS issued an extensive request for information seeking details about nearly all aspects of the MA program. They include care access data, prior authorization results, statistics related to patients’ outcomes and more. Still, Jayapal and Warren sought further enforcement action in their letter to the agency.
 
They gave qualified praise to steps CMS has already taken to limit overpayments.
 
Nonetheless, they noted, the Committee for a Responsible Federal Budget has projected that CMS will overpay MA insurers by as much as $1.56 trillion over the next decade. 
 
“As enrollment in MA continues to grow, CMS must take more aggressive action to ensure Medicare’s sustainability, protect taxpayer dollars, and curb abusive practices,” they said.

As Denials Climb, MACPAC Approves Recommendations for Managed Care Oversight 

McKnight’s Home Care | By Adam Healy

The Medicaid and CHIP Payment Advisory Commission on Friday approved seven recommendations to enhance congressional oversight of Medicaid managed care organizations as recent reports reveal startlingly high rates of prior authorization denials.

MACPAC’s recommendations aim to improve the prior authorization and appeals process by requiring MCOs to report relevant data to the Centers for Medicare & Medicaid Services. CMS would be required to release public reports on the data, as well as update regulations and create additional guidelines for MCOs’ use of prior authorization.

A recent investigation by the Office of the Inspector General found that 12.5% of prior authorization requests were denied by Medicaid MCOs, and about 2.7 million Medicaid beneficiaries were enrolled in MCOs with denial rates greater than 25%.

Thousands of prior authorization requests for elderly, chronically ill or disabled patients requiring home care were denied by MCOs, according to the report. 

“Few denials are appealed and little is known about the beneficiary experience,” Lesley Baseman, senior policy analyst at MACPAC, said during the Thursday meeting. “The appeals process is also challenging and burdensome for beneficiaries. Denial notices can be late in the mail and the content is often unclear, and beneficiaries encounter multiple barriers in accessing continuation of benefits.”

Part of the challenge, OIG’s investigation found, was that few guidelines for MCOs’ prior authorizations requests are currently in place.

States are not federally required to collect data on denials, continuation of benefits, or appeals outcomes, according to Baseman. Federal rules do not require states to assess clinical appropriateness of denials, she said, and they do not require that states publicly report information on denials and appeal outcomes.

OIG’s report also found that many MCOs employed staff who were not qualified to approve or deny requests, and most states lack safeguards to identify improper prior authorization denials.