AAH makes recs on Medicare Advantage 

WASHINGTON – AAHomecare has responded to a CMS request for information on Medicare Advantage data with recommendations to improve transparency in these plans. The association’s recommendations include: 

• Require MA plans to publish data that demonstrates they provide sufficient access to care and patient choice, including measures of beneficiary satisfaction and complaints, as well as the number of in-network DME suppliers by product category and geography. 
• Require MA plans to publish data regarding their appeal process for prior authorization (PA) decisions, as well as disclosing detailed PA approval/denial statistics by product category. 
• Require MA plans to disclose their use of artificial intelligence in PA and claims processing. 
• Require MA plans to disclose data on what benefits they cover under Part D that are also covered under Part B. Even though Medicare has determined that continuous glucose monitors (CGMs) are covered as DME under Part B and that MA plans are required to provide CGMs under Part B, many MA plans are covering these devices and related supplies under Part D prescription drug plans. 

“Comprehensive data on beneficiary satisfaction, access to care, authorization processes, denials/approvals, and coverage policies under MA plans benefits patients, caregivers, and healthcare providers,” AAHomecare stated. “This data is also critical to effective oversight and evaluation of these plans by legislators and regulators. AAHomecare will continue to press for measures that increase transparency in the Medicare Advantage space.” To read the comments in full, go here.