CMS Data Collection Tech Specs Signal ‘Existential Oversight’ on MA Plans

Jun 18
Jun 18, 2025

Following up on its plans to collect more granular information on coverage determinations and appeals made by Medicare Advantage plans, CMS on June 9 issued draft technical specifications as it seeks formal approval to implement the expanded Medicare Part C reporting requirements. Although it is a technical document on its surface that fulfills a procedural step, industry veterans say the notice signifies a massive widening of CMS’s view into coverage decisions and denials made by plans, providing the agency — and potentially the public — with unprecedented insight into areas such as the highly scrutinized prior authorization process.

“It’s a big deal,” says Mark Newsom, a former deputy director with CMS who recently joined Avalere Health as managing director. “Probably less from a burden perspective because plans ought to have pretty solid data on all these elements as part of their normal course of operations. It’s really more about the political risk of…more sunshine on denials and prior authorization and other issues” that have been under scrutiny by lawmakers on both sides of the aisle. It also means more attention from researchers, who could potentially identify outliers in the data, “so there’s a potential shaming aspect that could happen depending on how the data play out.”
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Lauren Flynn Kelly

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.