On June 28, the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce held a hearing entitled, "Protecting America's Seniors: Oversight of Private Sector Medicare Advantage (MA) Plans," aimed at addressing concerns raised by recent reports surrounding MA enrollees' access to medically necessary care and the fiscal sustainability of the MA program.

Witnesses from the Department of Health and Human Services (HHS) Office of Inspector General (OIG), the Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) provided an overview of their findings and recommendations to the Centers for Medicare and Medicaid Services (CMS) regarding addressing issues with the MA program, as well as status updates. The witnesses discussed potentially inappropriate payment denials from MA organizations for services that would have likely been approved under fee-for-service (FFS) Medicare; the use of chart reviews or health risk assessments for beneficiary diagnoses unsubstantiated by encounter data; concerns regarding beneficiary disenrollment in MA plans in the last year of life; and other concerns regarding inflationary coding practices, incomplete data submission, and more. The witnesses discussed several recommendations aimed at enhancing payment and data integrity and urged CMS to enhance their oversight of the MA program.

Bipartisan members of the subcommittee expressed general support for the MA program, many citing large enrollment numbers in their districts and general satisfaction from constituents; however, many also expressed a desire to enhance program efficiency, ensure appropriate and timely access to care, and keep costs and spending down. Several committee members expressed support for the Improving Seniors' Timely Access to Care Act of 2021 (H.R.3173/S.3018), aimed at streamlining prior authorization requirements under MA plans. Others focused on findings of improper payments due to coding intensity, CMS's lack of action in response to suggestions to improve timeliness of MA audits, ways to improve collection and validation of encounter data, and more. Several committee members also expressed their disapproval that CMS was not present at the hearing.

More information is available here.

Additional information is also available in the attached Tax Alert.

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Hearing on oversight of Medicare advantage plans