Stakeholders on Medicare Advantage: ‘We need an avenue to go to’

WASHINGTON – Industry stakeholders didn’t waste the opportunity to provide CMS with feedback on Medicare Advantage, telling the agency there’s an urgent need to improve oversight of the program. 

Industry organizations, state and regional associations, and individual providers all submitted comments to a request for information before an Aug. 31 deadline, says Laura Williard, vice president of payer relations for AAHomecare. 

“While there are some protections for Medicare beneficiaries, there are not a lot of regulations around protections for providers,” she said. “In our comments, we asked for an ombudsman or a liaison at CMS who has authority to ask questions and to, potentially, raise concerns. We need an avenue to go to for the industry.” 

CMS says the feedback will help inform the policy development and implementation process for Medicare Advantage.  

Just prior to the deadline, 2,341 comments had been submitted, according to Williard, many of them with consistent themes around not only improving oversight but also implementing more consistent policies and ensuring access to care. 

“Right now, there only has to be one provider in the network to meet access to care,” she said. “There are no guidelines around, there has to be a vent provider or a complex rehab provider in every area. That one provider in the network might not provide those services.” 

In its comments, AAHomecare also prioritized the need for a same or similar portal like traditional Medicare’s, a real-time prior authorization system for emergencies, and a policy that allows providers to follow patients who switch plans, Williard says. 

“We also asked them to help facilitate the inclusion of DME in accountable care organizations and value-based care models,” she said. “We want to make sure those opportunities are wide open for the industry.” 

Submitting comments was a good exercise in and of itself, helping stakeholders to get organized for potential next steps, says David Chandler, senior director of payer relations for AAHomecare. 

“We’ve put together an exhaustive list of areas where Medicare Advantage needs to be improved,” he said. “From here, we can look at what can be accomplished through regulatory means with CMS or through other routes.” 

The request for information is also timely, Williard says, with a recent Office of Inspector General report and a congressional hearing spotlighting concerns with Medicare Advantage. Additionally, 50% of Medicare beneficiaries are expected to be covered by these plans in 2023 and more than 60% by 2032. 

“With an RFI, CMS doesn’t have to respond,” she said. “However, our hope is that with the vast number of comments, there will continue to be an increased focus.”