On May 29, 2024, Aimed Alliance submitted a response to the Centers for Medicare & Medicaid Service’s (CMS) request for information regarding Medicare Advantage (MA) data. The comment discussed concerns regarding the utilization of prior authorization and step therapy in MA plans, such as high denial rates and high overturn rates on appeal. To better understand how these policies are impacting MA beneficiaries, Aimed Alliance advocated for CMS to mandate the collection of comprehensive data on prior authorization and step-therapy processes, including denials, appeals, and justifications. Additionally, the submission called for the reporting of post-service denials, out-of-pocket spending, and disenrollment reasons to identify trends, disparities, and challenges within MA plan administration. Ultimately, the call for strong data collection efforts aims to foster a more transparent, accountable, and equitable healthcare system for all MA beneficiaries. Read Aimed Alliance’s comment here.
Last Updated on May 31, 2024 by Aimed Alliance
