Medicare Program; Request for Information on Medicare Advantage Data, 5907-5909 [2024-01832]

Download as PDF Federal Register / Vol. 89, No. 20 / Tuesday, January 30, 2024 / Notices procedures. On February 21, 2006, we issued our decision memorandum on bariatric surgery procedures. We determined that bariatric surgical procedures are reasonable and necessary for Medicare beneficiaries who have a body-mass index (BMI) greater than or equal to 35, have at least one comorbidity related to obesity and have been previously unsuccessful with medical treatment for obesity. This decision also stipulated that covered bariatric surgery procedures are reasonable and necessary only when performed at facilities that are: (1) certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for Bariatric Surgery (ASBS) as a Bariatric Surgery Center of Excellence (BSCOE) (program standards and requirements in effect on February 15, 2006). There were no additions, deletions, or editorial changes to Medicare-approved facilities that meet CMS’ minimum facility standards for bariatric surgery that have been certified by ACS and/or ASMBS in the 3-month period. This information is available at www.cms.gov/MedicareApproved Facilitie/BSF/list.asp#TopOfPage. For questions or additional information, contact Sarah Fulton, MHS (410–786–2749). Addendum XV: FDG–PET for Dementia and Neurodegenerative Diseases Clinical Trials (October Through December 2023) There were no FDG–PET for Dementia and Neurodegenerative Diseases Clinical Trials published in the 3-month period. This information is available on our website at www.cms.gov/Medicare ApprovedFacilitie/PETDT/list.asp# TopOfPage. For questions or additional information, contact David Dolan, MBA (410–786–3365). [FR Doc. 2024–01785 Filed 1–29–24; 8:45 am] khammond on DSKJM1Z7X2PROD with NOTICES BILLING CODE 4120–01–P VerDate Sep<11>2014 17:23 Jan 29, 2024 Jkt 262001 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 Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). ACTION: Request for information. AGENCY: 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. SUMMARY: 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 https://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 DATES: PO 00000 Frm 00053 Fmt 4703 Sfmt 4703 5907 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: https:// 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/buildingcms-strategic-vision-working-togetherstronger-medicare) and the CMS Strategic Pillars (https://www.cms.gov/ about-cms/what-we-do/cms-strategicplan). 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 highquality 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 E:\FR\FM\30JAN1.SGM 30JAN1 5908 Federal Register / Vol. 89, No. 20 / Tuesday, January 30, 2024 / Notices khammond on DSKJM1Z7X2PROD with NOTICES has for the first time reached half of all people enrolled in Medicare.1 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 postacute 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 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-medicareprescription-drug-programs-remain-stable-2024. 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/reportsand-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-0319-00432.asp; https://www.medpac.gov/wpcontent/uploads/import_data/scrape_files/docs/ default-source/reports/jun19_ch7_medpac_reportto VerDate Sep<11>2014 17:23 Jan 29, 2024 Jkt 262001 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 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 congress_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-03-2100380.asp. 3 https://www.cms.gov/newsroom/fact-sheets/ 2024-medicare-advantage-and-part-d-final-rulecms-4201-f. 4 https://www.cms.gov/newsroom/fact-sheets/ contract-year-2025-policy-and-technical-changesmedicare-advantage-plan-program-medicare; https://www.cms.gov/newsroom/fact-sheets/ contract-year-2024-policy-and-technical-changesmedicare-advantage-and-medicare-prescriptiondrug. 5 https://www.cms.gov/medicare/enrollmentrenewal/health-plans/part-c. 6 https://www.cms.gov/newsroom/fact-sheets/ contract-year-2024-policy-and-technical-changesmedicare-advantage-and-medicare-prescriptiondrug; https://www.cms.gov/newsroom/fact-sheets/ contract-year-2025-policy-and-technical-changesmedicare-advantage-plan-program-medicare. 7 https://www.cms.gov/newsroom/fact-sheets/ cms-interoperability-and-prior-authorization-finalrule-cms-0057-f. 8 https://www.cms.gov/regulations-and-guidance legislationpaperworkreductionactof1995pra-listing/ cms-10718. PO 00000 Frm 00054 Fmt 4703 Sfmt 4703 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 decisionmaking; 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 E:\FR\FM\30JAN1.SGM 30JAN1 5909 Federal Register / Vol. 89, No. 20 / Tuesday, January 30, 2024 / Notices 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 DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Submission for Office of Management and Budget Review; Office of Human Services Emergency Preparedness and Response Disaster Human Services Case Management Intake Assessment, Resource Referral, and Case Management Plan Office of Human Services Emergency Preparedness and Response, Administration for Children and Families, U.S. Department of Health and Human Services. ACTION: Request for public comments. AGENCY: The Office of Human Services Emergency Preparedness and Response (OHSEPR), Administration for Children and Families (ACF), U.S. Department of Health and Human Services (HHS), is requesting an extension for approval of the following information collection: OHSEPR Disaster Human Services Case Management Intake Assessment, SUMMARY: Resource Referral, and Case Management Plan; OMB No.: 0970– 0619. This information collection was originally approved for 6 months through an emergency approval. Comments due within 30 days of publication. OMB is required to make a decision concerning the collection of information between 30 and 60 days after publication of this document in the Federal Register. Therefore, a comment is best assured of having its full effect if OMB receives it within 30 days of publication. DATES: Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to www.reginfo.gov/public/do/ PRAMain. Find this particular information collection by selecting ‘‘Currently under 30-day Review—Open for Public Comments’’ or by using the search function. You can also obtain copies of the proposed collection of information by emailing infocollection@ acf.hhs.gov. All emailed requests should be identified by the title of the information collection. ADDRESSES: SUPPLEMENTARY INFORMATION: Description: OHSEPR is seeking to continue data collection with all forms approved under OMB No. 0970–0619, which OMB recently approved through an emergency approval for 6 months. OHSEPR’s Disaster Human Services Intake Assessment, Resource Referral, and Case Management Plan collection is part of a system of tools that OHSEPR utilizes to support disaster survivors during response missions. OHSEPR’s case managers would use this collection during an intake assessment to identify a disaster survivor’s unmet needs and to work with the survivor to develop a case management plan based on the survivor’s responses. Respondents: Disaster survivors. ANNUAL BURDEN ESTIMATES Annual number of respondents khammond on DSKJM1Z7X2PROD with NOTICES Data collection Total number of responses per respondent Average burden hours per response Annual burden hours Disaster Human Services Case Management Intake Assessment—Survivor ........................................................................................................ Case Management Plan—Case Manager ................................................. Resource Referral Form—Case Manager ................................................. Case Record Notes—Case Manager ........................................................ Survivor Satisfaction Survey—Survivor ..................................................... 9,000 180 180 180 9,000 1 50 50 50 1 1.5 1 1 1 .25 13,500 9,000 9,000 9,000 2,250 Estimated Total Annual Burden Hours: .............................................. ........................ .............................. ........................ 42,750 Authority: The Disaster Human Services Case Management Program is VerDate Sep<11>2014 17:23 Jan 29, 2024 Jkt 262001 authorized through appropriations language under the Children and PO 00000 Frm 00055 Fmt 4703 Sfmt 4703 Families Services account. It is operated by the ACF Office of Human Services E:\FR\FM\30JAN1.SGM 30JAN1

Agencies

[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.

-----------------------------------------------------------------------

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 https://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: https://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\
---------------------------------------------------------------------------

    \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.
---------------------------------------------------------------------------

    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\
---------------------------------------------------------------------------

    \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.
---------------------------------------------------------------------------

    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\
---------------------------------------------------------------------------

    \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.
---------------------------------------------------------------------------

    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
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