Association supports data transparency of Medicare Advantage plans

ADA responds to request for information from CMS

The ADA is responding to a request for information on Medicare Advantage data from the Centers for Medicare and Medicaid Services by emphasizing the importance of increasing data transparency and reporting from insurers.
 
A letter from the ADA to CMS Administrator Chiquita Brooks-LaSure stated the utilization of dental care through Medicare Advantage and related cost-sharing and marketing practices should be further examined, considering more than half of Medicare beneficiaries now choose these plans.
 
“The information collected through this proposal is essential to understanding dental needs of Medicare [Advantage] beneficiaries, while highlighting potential access to care issues that may arise with the rapid growth of Medicare Advantage,” the letter states before delving into the ADA-supported areas of data transparency of Medicare Advantage plans.
 
The ADA supports public reporting Medicare Advantage plan utilization metrics including the percentage of beneficiaries who submitted claims for any dental service within the plan year, as well as the number and percentage of procedures utilized according to broad Current Dental Terminology categories such as preventive, diagnostic or restorative procedures. 
 
According to the letter, these metrics help agencies and research institutions verify whether procedures are positively impacting overall patient health. 

The ADA also expressed support for the public reporting of CMS metrics tied to insurer and consumer spending. These include the average coinsurance by category of covered procedure, percentage of supplemental dental benefits from Medicare Advantage plans that are mandatory vs. optional, percentage of dental claims submitted to Medicare Advantage plans that are denied due to medical necessity or prior authorizations, and marketing dollars spent highlighting a dental feature vs. benefit utilization.
 
The ADA said that reporting on these metrics “can help enlighten federal agencies or partners to when insurers are adding supplemental dental benefits to appeal to consumers with the knowledge that these benefits will not be utilized due to a certain geographic area having a higher share of dual-eligible beneficiaries or lower network adequacy or other insurer barriers.”
 
The letter states the ADA supports CMS publishing network adequacy metrics for Medicare Advantage plans which will help consumers decipher whether the promised benefits  will lead to increased dental care access for beneficiaries. It also expressed support for public CMS reporting of Medicare Advantage plan patient satisfaction results, “especially involving those plans’ supplemental dental benefits.” Transparency regarding patient satisfaction with  plans will help determine how effectively the supplemental dental benefit is being used, the ADA said. 
 
For more information about the ADA’s advocacy efforts, visit ADA.org/Advocacy.