MGMA feedback on CY 2026 MA Proposed Rule (January 27, 2025)

Advocacy Letter

Home > Press Statements & Advocacy Letters > Advocacy Letters

1/27/2025

January 27, 2025

Mr. Jeff Wu
Acting Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244-1850

Re: [CMS-4208-P]. RIN 0938-AV40 Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (2026 MA Proposed Rule)

Dear Mr. Wu:

The Regulatory Relief Coalition (RRC) is pleased to have the opportunity to comment on the Contract Year 2026 Medicare Advantage (MA) Proposed Rule (the “Proposed Rule”) referenced above. The RRC is a coalition of national physician specialty organizations seeking to reduce regulatory burdens that interfere with patient care. Our recent activities focus on ensuring that utilization review policies are not a barrier to timely and equitable access to care for the patients we serve.

The 2026 MA Proposed Rule includes several provisions of interest to the RRC, including provisions related to prior authorization (PA), provider directories, MA plans’ internal coverage criteria policies, and the Medicare Loss Ratio (MLR). Our comments are set forth below.

Disaggregation of PA Data
First, and most importantly, we are extremely pleased that, consistent with the RRC’s prior comments on PA transparency, the Proposed Rule would require that MA plans’ PA data reporting be disaggregated and reported based on the individual item or service involved. In its comments on the 2024 and 2025 MA Proposed Rules, the RRC had urged CMS to require MA plans to disaggregate all PA data that is required to be made public under Medicare rules. The RRC believes that it is critical that PA data be disclosed on an individual service basis, since disclosure on an aggregate basis is virtually meaningless to both providers and patients. Moreover, we have long believed that, unless PA data is available on a service level, it will not be possible to focus efforts to reduce the potential disproportionate impact of PA on disabled and dual eligible enrollees to target the particular service lines requiring priority attention.