‘We need an avenue to go’ |


WASHINGTON — Industry stakeholders didn’t miss an opportunity to provide CMS with feedback on Medicare Advantage, telling the agency there is an urgent need to improve oversight of the program.

Industry organizations, state and regional associations and individual providers all submitted comments to a request for information by the Aug. 31 deadline, said Laura Williard, vice president of payer relations for AAHomecare.

“While there are some protections for Medicare beneficiaries, there aren’t many regulations regarding protections for providers,” she said. “In our comments, we asked for an ombudsman or liaison officer at CMS who has the authority to ask questions and possibly raise concerns. We need an avenue for the industry to go.

CMS says the feedback will help inform the policy development and implementation process for Medicare Advantage.

Just before the deadline, 2,341 comments had been submitted, according to Williard, many with consistent themes around not only improving surveillance, but also implementing more consistent policies and ensuring access to information. care.

“At this time, there must be only one provider in the network to respond to access to care,” she said. “There are no guidelines, there must be a ventilation provider or a complex rehab provider in each area. This network provider may not provide these services. »

In its comments, AAHomecare also prioritized the need for the same or similar portal as traditional Medicare, a real-time pre-authorization system for emergencies, and a policy for providers to track patients who change plans, says Williard.

“We also asked them to help facilitate EMR inclusion in accountable care organizations and value-based models of care,” she said. “We want to make sure these opportunities are wide open for the industry.”

Submitting feedback was a good exercise in itself, helping stakeholders organize for potential next steps, says David Chandler, senior director of payer relations for AAHomecare.

“We’ve compiled a comprehensive list of areas where Medicare Advantage needs improvement,” he said. “From there, we can look at what can be accomplished through regulatory means with CMS or through other avenues.”

The request for information is also timely, Williard says, with a recent report from the Office of Inspector General and a congressional hearing highlighting concerns about Medicare Advantage. Additionally, 50% of Medicare beneficiaries are expected to be covered by these plans by 2023 and more than 60% by 2032.

“With an RFI, CMS doesn’t have to respond,” she said. “However, we hope that with the large number of comments, attention will continue to be increased.”

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