Press CMS to fully utilize its authority to regulate MA plans – finalize strong rules (many already proposed) and ramp up enforcement.
Push CMS to turn existing oversight authority into consistent, visible consequences for plans that deny or delay covered care. Pair rule finalization with a steady enforcement cadence—audits, sanctions, and public reporting—so compliance is cheaper than non-compliance. The near-term focus is follow-through on the oversight changes CMS has already been rolling out for 2024 and 2025.
Why this works
- CMS can act relatively quickly and doesn’t need new legislation for many steps.
- For example, it can clarify that failure to provide medically necessary care violates contracts, enabling sanctions.
- Recently finalized rules show CMS is willing to assert itself.
- Strong enforcement would directly deter plan misconduct and protect seniors’ rights.
National Committee to Preserve Social Security and Medicare
AdvocacyProtecting and enhancing retirement and health security for seniors
Mechanism
About LobbyingHow National Committee to Preserve Social Security and Medicare uses funding
- Identify which finalized and proposed CMS rules matter most for medically necessary care and prior authorization.
- Submit comments and meet with CMS to prioritize audits, sanctions, and clearer public reporting.
- Push guidance that limits plan medical criteria and aligns decisions with Medicare coverage rules.
- Track enforcement actions and surface patterns of repeat non-compliance.
- Route beneficiary and provider reports into oversight channels that can trigger audits.
Milestones
Checkpoints and the expected timing for each step
- 1
Enforcement priorities clarified
Near termPriority rules, audits, and reporting asks are agreed.
- 2
Guidance and reporting package advanced
Near termCMS releases clearer expectations for plans and oversight.
- 3
Enforcement cadence established
OngoingAudits and sanctions occur with visible follow-through.
- 4
Outcomes tracked against win condition
Within 24 months (win condition)Violations and improper denials decline toward the stated target.