On February 16, 2023, Representatives Pramila Jayapal (WA-07), Rosa DeLauro (CT-03), and Jan Schakowsky (IL-09) led a letter of 70 members of the U.S. House of Representatives calling on the Centers for Medicare & Medicaid Services (CMS) to implement reforms to Medicare Advantage (MA), including:
- Finalize and strongly enforce the proposed prohibition on MA plans denying prior authorization requests for coverage of a Medicare covered item or service based on criteria not found in traditional Medicare coverage policies, and issue new guidance prohibiting the use of step therapy for Medicare Part B (note: see the Center for Medicare Advocacy’s comments to this and other provisions in a recent proposed rule here).
- Require MA plans to cover services provided by any medical provider that accepts Medicare’s approved rate. At a minimum, require MA networks to cover care at the top 50 cancer hospitals in the country.
- Stop overpayments by developing a more accurate risk scoring model based on patient demographics and prohibiting the use of unscrupulous methods to increase care costs (note: see the Center’s Alert concerning MA overpayments and the insurance industry’s response here).
- Reinvest the $46.5 billion annual savings from MA overpayments into lowering Medicare premiums, eliminating deductibles, expanding benefits to include dental, vision, and hearing, or otherwise improving medical care for all Medicare beneficiaries.
The Center for Medicare Advocacy applauds these members of Congress for standing up for all Medicare beneficiaries, including their constituents enrolled in Medicare Advantage plans who would helped by these reforms.