FAH Hospital Policy Blog

Perspectives on health policy affecting America's hospitals and the patients we serve.

FAH Policy Blog Team

FAH Advocates for MA Program Data Improvements

Today, FAH responded to CMS’ request for information on the Medicare Advantage data with a comprehensive letter outlining five key information gaps where additional MA data would improve oversight.

Utilization Management: Require Medicare Advantage Organizations (MAOs) to report detailed use of utilization prior authorization use, denial rates, appeal rates, and response times by type of service to provide transparency and improve accountability.
Network Adequacy: Foster provider network transparency and make the information more timely and publicly available to ensure patients are as fully informed as possible on their provider choices.
Advance Health Equity: Continue data collection, public reporting, and research on care disparities that may be affecting vulnerable populations.
MA Encounter Data: Evaluate the completeness of MAO’s submitted data, report performance metrics, and penalize plans for deficient data reporting.
Transparency of Information on Medical Loss Ratio (MLR): Require MAOs to report further data on MLRs and make the information publicly available.

The response letter is part of FAH’s ongoing advocacy in urging lawmakers and regulators to combat managed care abuses that affect patient access to care.

Read the letter here.