11/14/2024

LeadingAge Weighs in on CMS Plans to Collect and Audit MA Plan Data on Internal Coverage Criteria

The Centers for Medicare & Medicaid Services (CMS) issued another proposal to collect data from Medicare Advantage (MA) plans to assist in enforcing the CY2024 MA rules governing under what circumstances MA plans can use internal coverage criteria (ICC) to make coverage determinations.

On November 12, LeadingAge offered both support for this data collection effort and feedback about how it could be improved. The proposal outlines a list of items that all plans will be required to report to CMS on ICC and a more comprehensive set of information that select plans would be required to submit as part of an audit of ICC.

LeadingAge supports this effort to ensure these ICC are only being used limitedly and when appropriate to determine access to Medicare services. It is not clear when this new data collection effort will be initiated but LeadingAge encouraged CMS to implement starting January 1, 2025.

To read LeadingAge’s full comment letter, click here.