backCMS Solicits Comments on Improving Medicare Advantage Data Transparency—
On January 25, 2024, CMS released a Request for Information (RFI) seeking public input on how it can enhance and increase transparency of Medicare Advantage (MA) data. CMS says that the RFI “builds on our existing MA data transparency efforts to further align with Traditional Medicare and provide the data we need to ensure the growing Medicare Advantage program best meets the needs of enrollees.” The agency has invited comments from all interested parties, including MA plans, providers, and academic researchers. Comments to the RFI are due 120 days after the date it is published in the Federal Register, which is currently scheduled to occur on January 30, 2024.
This RFI was spurred by feedback CMS received from a previous RFI. On August 1, 2022, CMS solicited comments on how best to improve the MA program. Commenters to that RFI said that CMS should collect and publish more MA program data, including data about supplemental benefit cost and utilization, value-based payment arrangements between providers and plans, utilization management and prior authorization, claim denials and appeals, network adequacy, market competition, etc. The calls for greater transparency of MA data were echoed by OIG, the Government Accountability Office, and MedPAC.
The RFI published last week requests comments on all data related to the MA program, including both data that is and is not currently collected. CMS is particularly interested in hearing about “common challenges and experiences in the MA program for which limited data are currently available.” The agency says that the information solicited by the RFI will support efforts to ensure that there is healthy competition in the market for MA plans and that MA plans are meeting the needs of beneficiaries and appropriately using taxpayer funds.
CMS is specifically soliciting comments on data-related recommendations concerning beneficiary access to care, including provider directories and networks; prior authorization and utilization management, including denials of care and the appeals process; cost and utilization of supplemental benefits; MA marketing and consumer decision-making; care quality and outcomes; MA plan market competition; and special populations of MA beneficiaries such as individuals eligible for Medicare and Medicaid and ESRD patients.
For each data-related recommendation, CMS requests that commentors explain the rationale, goals and questions that could be addressed with newly released data, and how such data could support new action or CMS regulations.
The RFI encourages MA plans, providers, and data vendors to comment on the operational considerations of collecting additional MA data. CMS is also seeking comments on how it can improve how MA data is collected and released to the public.
The RFI is available here, and a CMS press release about the RFI is available here.
Reporter, Alek Pivec, Washington D.C., +1 202 626 2914, apivec@kslaw.com.
OCR Provides Guidance Regarding Patient Visitation Rights
On January 25, 2024, HHS Office for Civil Rights (OCR) issued guidance and responses to frequently asked questions regarding nondiscrimination regulations related to patient visitation. Hospitals, long term care facilities, and critical access hospitals that participate in Medicare and Medicaid have nondiscrimination obligations regarding patient visitation. Additionally, all entities that receive federal funding are obligated to comply with federal civil rights laws. These facilities must ensure that all patients enjoy visitation privileges in a nondiscriminatory manner. Patients do not have to be Medicare or Medicaid beneficiaries to have patient visitation rights.
For facilities subject to these federal laws and regulations, patients have the right to receive visitors without discrimination, and individuals with disabilities also have a right to be accompanied by a support person in specific situations.
There are several nondiscrimination regulations that prohibit discrimination in patient visitation policies. OCR enforces the prohibition on religious discrimination, and CMS enforces the prohibitions on discrimination on the basis of race, color, national origin, sex, gender identity sexual orientation or disability. During the COVID-19 pandemic, OCR received several complaints regarding patient visitation rights regarding religious discrimination. This new guidance set out to respond to many of these frequently asked questions.
All facilities must have written policies and procedures regarding patient visitation rights, including any clinically necessary or reasonable restrictions on visitation rights and the reasons for the clinical restriction or other limitation. Facilities may limit access as long as: (1) the restrictions are clinically necessary or otherwise reasonable; (2) the facility informs patients in advance whenever possible; (3) the policy is maintained in writing; and (4) visitation privileges are not restricted based on race, color, national origin, religion, sex, gender identity, sexual orientation, or disability. Visitation restrictions may also be based on safety reasons based on actual risks, such as limiting the number of patient visitors during the COVID-19 pandemic.
A facility may violate CMS regulations or federal civil rights laws if it subjects certain classes of visitors to additional screening or prohibits them from visitation. Facilities should ensure that religious leaders or other spiritual support persons from particular faiths are not discriminated against. Facilities must also not base a visitation policy or procedure based on stereotypes about communities and communicable diseases. Patients have the right to receive visitors of their choosing (both in-person or virtually), which can only be limited by clinically necessary or reasonable restrictions. This includes clinically necessary or reasonable restrictions on interactions with visitors, such as requiring visitors to wear protective gear during a communicable disease outbreak. There are additional protections for special access to residents of long-term care facilities.
OCR’s FAQs on patient visitation can be found here.
Reporter, Lindsay Greenblatt, Los Angeles, +1 213 218 4032, lgreenblatt@kslaw.com.