[Federal Register Volume 89, Number 20 (Tuesday, January 30, 2024)]
[Notices]
[Pages 5907-5909]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-01832]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-4207-NC]
RIN 0938-ZB84


Medicare Program; Request for Information on Medicare Advantage 
Data

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of 
Health and Human Services (HHS).

ACTION: Request for information.

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SUMMARY: 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.

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

ADDRESSES: In commenting, refer to file code CMS-4207-NC.
    Comments, including mass comment submissions, must be submitted in 
one of the following three ways (please choose only one of the ways 
listed):
    1. Electronically. You may submit electronic comments on this 
document to http://www.regulations.gov. Follow the ``Submit a comment'' 
instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Attention: CMS-4207-NC, P.O. Box 8013, 
Baltimore, MD 21244-8013.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address ONLY: Centers for Medicare & Medicaid Services, 
Department of Health and Human Services, Attention: CMS-4207-NC, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Ilina Chaudhuri, (410) 786-8628.

SUPPLEMENTARY INFORMATION: 
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following 
website as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that website to 
view public comments. CMS will not post on Regulations.gov public 
comments that make threats to individuals or institutions or suggest 
that the individual will take actions to harm the individual. CMS 
continues to encourage individuals not to submit duplicative comments. 
We will post acceptable comments from multiple unique commenters even 
if the content is identical or nearly identical to other comments.

I. Background

    In a request for information that appeared in the Federal Register 
on August 1, 2022 (87 FR 46918) (hereinafter referred to as 2022 
General MA RFI), CMS sought feedback on ways to strengthen Medicare 
Advantage (MA) to align with the Vision for Medicare (https://www.cms.gov/blog/building-cms-strategic-vision-working-together-stronger-medicare) and the CMS Strategic Pillars (https://www.cms.gov/about-cms/what-we-do/cms-strategic-plan). The 2022 General MA RFI set 
out to create more opportunities for stakeholders to engage with CMS, 
and in alignment with the agency's Strategic Pillars, prioritize 
increased engagement throughout the policy process with our partners 
and the communities we serve. As a result of this commitment, we 
received more than 4,000 responses from a wide variety of voices. One 
key theme that emerged was an interest in greater beneficiary 
protections, such as strengthened MA marketing regulations and prior 
authorization protections. Respondents also focused on issues related 
to payment, including accurate risk adjustment and value-based payment 
arrangements between providers and insurers, as well as competition in 
the market, such as topics related to insurer consolidation and 
vertical integration. Additionally, we received strong feedback from 
respondents who stated that CMS should have comprehensive high-quality 
MA programmatic data and promote more program transparency through 
increased public releases of MA data. Respondents underscored the 
urgency for more complete MA data and data transparency as enrollment 
in MA

[[Page 5908]]

has for the first time reached half of all people enrolled in 
Medicare.\1\
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    \1\ From ``Medicare Advantage and Medicare Prescription Drug 
Programs to Remain Stable in 2024'', available at https://www.cms.gov/newsroom/press-releases/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-2024.
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    Recommendations regarding MA data included calls for CMS to collect 
and release more MA data on key areas of concern, such as supplemental 
benefit costs and utilization, value-based payment arrangements between 
providers and plans, utilization management and prior authorization 
including denials and appeals and access to inpatient services and 
post-acute care, network adequacy and provider directory accuracy, 
competitive forces in the market such as the effects of market shifts 
and vertical integration and consolidation on consumers, care outcomes, 
and Medicare Loss Ratios (MLRs). Commenters also raised data 
considerations on topics such as MA marketing activity, especially 
predatory behavior, care outcomes and data available in MA compared to 
Traditional Medicare (Medicare Parts A and B), and geographic impacts 
including on rural areas, among other important topic areas. 
Respondents emphasized that CMS should improve its data capabilities to 
measure impacts of MA on underserved communities. HHS' Office of 
Inspector General (OIG), the Government Accountability Office (GAO), 
and the Medicare Payment Advisory Commission (MedPAC) have pointed out 
program areas that would benefit from better or more MA data as 
well.\2\
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    \2\ Examples of such studies and reports include: ``Priority 
Open Recommendations: Department of Health and Human Services.'' May 
2023. https://www.gao.gov/assets/gao-23-106467.pdf; ``The Inability 
To Identify Denied Claims in Medicare Advantage Hinders Fraud 
Oversight.'' OEI-03-21-00380. March 2023. https://oig.hhs.gov/oei/reports/OEI-03-21-00380.asp; ``Medicare Advantage: Plans Generally 
Offered Some Supplemental Benefits, but CMS Has Limited Data on 
Utilization.'' Jan 2023. https://www.gao.gov/products/gao-23-105527; 
``OIG's Top Unimplemented Recommendations: Solutions to Reduce 
Fraud, Waste, and Abuse in HHS Programs.'' 2022. https://oig.hhs.gov/reports-and-publications/compendium/files/compendium2022.pdf; ``CMS Generally Ensured That Medicare Part C and 
Part D Sponsors Did Not Pay Ineligible Providers for Services to 
Medicare Beneficiaries.'' A-02-20-01027. Oct 2022. https://oig.hhs.gov/oas/reports/region2/22001027.pdf; ``Some Medicare 
Advantage Organization Denials of Prior Authorization Requests Raise 
Concerns About Beneficiary Access to Medically Necessary Care.'' 
OEI-09-18-00260. Apr 2022. https://oig.hhs.gov/oei/reports/oei-09-18-00260.asp; ``Medicare Advantage Organizations Are Missing 
Opportunities To Use Ordering Provider Identifiers to Protect 
Integrity.'' OEI Report OEI-03-19-00432. Apr 2021. https://oig.hhs.gov/oei/reports/OEI-03-19-00432.asp; https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/jun19_ch7_medpac_reporttocongress_sec.pdf; ``The Inability 
To Identify Denied Claims in Medicare Advantage Hinders Fraud 
Oversight.'' (OEI-03-21-00380) March 2023. https://oig.hhs.gov/oei/reports/OEI-03-21-00380.asp.
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    During the Biden-Harris Administration, we have finalized policies 
for 2024 \3\ and proposed policies \4\ that will improve MA data 
capabilities, among other important MA policy changes. We have also 
issued requirements for collecting more data related to supplemental 
benefits in the updated Part C reporting requirements,\5\ required MA 
organizations to improve prior authorization processes \6\ and final 
interoperability requirements,\7\ and begun collecting race and 
ethnicity data on a voluntary basis on MA and Part D enrollment 
forms.\8\
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    \3\ https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f.
    \4\ https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare; https://www.cms.gov/newsroom/fact-sheets/contract-year-2024-policy-and-technical-changes-medicare-advantage-and-medicare-prescription-drug.
    \5\ https://www.cms.gov/medicare/enrollment-renewal/health-plans/part-c.
    \6\ https://www.cms.gov/newsroom/fact-sheets/contract-year-2024-policy-and-technical-changes-medicare-advantage-and-medicare-prescription-drug; https://www.cms.gov/newsroom/fact-sheets/contract-year-2025-policy-and-technical-changes-medicare-advantage-plan-program-medicare.
    \7\ https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f.
    \8\ https://www.cms.gov/regulations-and-guidancelegislationpaperworkreductionactof1995pra-listing/cms-10718.
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    This RFI is an extension of our ongoing work on MA data as we 
solicit feedback from the public on how best to meet the shared goals 
of enhancing data capabilities to have better insight into our 
programs, consider areas to increase MA data transparency, and propose 
future rulemaking. Our eventual goal is to have, and make publicly 
available, MA data commensurate with data available for Traditional 
Medicare to advance transparency across the Medicare program, and to 
allow for analysis in the context of other health programs like 
accountable care organizations, the Marketplace, Medicaid managed care, 
integrated delivery systems, among others.

II. Solicitation of Public Comments

    We encourage feedback from a wide array of interested parties, 
including beneficiaries and beneficiary advocates, plans, providers, 
community-based organizations, researchers, employers and unions, and 
all other interested parties, including the public at large. Our 
interest in this RFI is to solicit comments on all aspects of data 
related to the MA program. Intimate knowledge of CMS' current data 
availability or capability is not needed to provide input on the 
aspects of MA for which commenters think policymakers and the public 
should have more data.
    In this RFI, CMS requests comments on all aspects of data related 
to the MA program--both data not currently collected as well as data 
currently collected. We are especially interested in: data-related 
recommendations related to beneficiary access to care including 
provider directories and networks; prior authorization and utilization 
management, including denials of care and beneficiary experience with 
appeals processes as well as use and reliance on algorithms; cost and 
utilization of different supplemental benefits; all aspects of MA 
marketing and consumer decision-making; care quality and outcomes, 
including value-based care arrangements and health equity; healthy 
competition in the market, including the impact of mergers and 
acquisitions, high levels of enrollment concentration, and the effects 
of vertical integration, data topics related to Medicare Advantage 
prescription drug plans (MAPDs); and special populations such as 
individuals dually eligible for Medicare and Medicaid, individuals with 
end stage renal disease (ESRD), and other enrollees with complex 
conditions. We ask that academic researchers and other data analysts 
provide precise detail and definitions on the data format, fields, and 
content that would facilitate comprehensive analyses of any publicly 
released MA data, including comparisons with existing data sets, for 
example, between Traditional Medicare and MA. Additionally, we seek 
detail regarding the rationale, goals, and questions that you could 
address with newly released data and suggestions for how such data 
could support new action or regulation by CMS. We are also interested 
to hear if you have insight in ways in which CMS could leverage 
existing private sector data.
    It would also be helpful for plans, providers, data vendors, and 
other stakeholders with a deep understanding of MA data to provide 
recommendations related to operational considerations as part of this 
effort. Comments are welcome on ways that we could improve our current 
MA data collection and release methods, including recommendations on 
the preferred cadence of data releases. Finally, we seek detailed 
information from beneficiary advocates, health care providers, and 
other stakeholders on common challenges and experiences in

[[Page 5909]]

the MA program for which limited data are currently available.

III. Collection of Information Requirements

    This is a request for information (RFI) only. In accordance with 
the implementing regulations of the Paperwork Reduction Act of 1995 
(PRA) (44 U.S.C. 3501 et seq.), specifically 5 CFR 1320.3(h)(4), this 
general solicitation is exempt from the PRA. Facts or opinions 
submitted in response to general solicitations of comments from the 
public, published in the Federal Register or other publications, 
regardless of the form or format thereof, provided that no person is 
required to supply specific information pertaining to the commenter, 
other than that necessary for self-identification, as a condition of 
the agency's full consideration, are not generally considered 
information collections and therefore not subject to the PRA.
    This RFI is issued solely for information and planning purposes; it 
does not constitute a Request for Proposal (RFP), applications, 
proposal abstracts, or quotations. This RFI does not commit the U.S. 
Government to contract for any supplies or services or make a grant 
award. Further, we are not seeking proposals through this RFI and will 
not accept unsolicited proposals. Responders are advised that the U.S. 
Government will not pay for any information or administrative costs 
incurred in response to this RFI; all costs associated with responding 
to this RFI will be solely at the interested party's expense. In 
addition, this RFI does not commit the Government to any policy 
decision and CMS will follow established methods for proposing future 
policy changes, including the MA Advance Notice and Rate Announcement 
process. We note that not responding to this RFI does not preclude 
participation in any future procurement or rulemaking, if conducted. It 
is the responsibility of the potential responders to monitor this RFI 
announcement for additional information pertaining to this request. In 
addition, we note that CMS will not respond to questions about the 
policy issues raised in this RFI.
    Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & 
Medicaid Services, approved this document on January 22, 2024.

    Dated: January 25, 2024.
Xavier Becerra,
Secretary, Department of Health and Human Services.
[FR Doc. 2024-01832 Filed 1-25-24; 4:15 pm]
BILLING CODE 4120-01-P