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Medicare Advantage accountability
Medicare Advantage accountability
Lobbying

Regulatory Enforcement & Rulemaking

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

Advocacy
ncpssm.org

Protecting and enhancing retirement and health security for seniors

The National Committee to Preserve Social Security and Medicare (NCPSSM) is a grassroots advocacy organization founded in 1982 to serve as an advocate in Washington for the financial security of seniors. NCPSSM fights against cuts to Social Security and Medicare, pushes for benefit improvements (like more accurate COLAs), and works to ensure these programs’ long-term solvency. With millions of members and supporters, the Committee lobbies Congress, conducts public education, and organizes seniors to speak out on issues such as prescription drug pricing and protection from inflation.

Mechanism

About Lobbying

How National Committee to Preserve Social Security and Medicare uses funding

  1. Identify which finalized and proposed CMS rules matter most for medically necessary care and prior authorization.
  2. Submit comments and meet with CMS to prioritize audits, sanctions, and clearer public reporting.
  3. Push guidance that limits plan medical criteria and aligns decisions with Medicare coverage rules.
  4. Track enforcement actions and surface patterns of repeat non-compliance.
  5. Route beneficiary and provider reports into oversight channels that can trigger audits.
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Milestones

Checkpoints and the expected timing for each step

  1. 1

    Enforcement priorities clarified

    Near term

    Priority rules, audits, and reporting asks are agreed.

  2. 2

    Guidance and reporting package advanced

    Near term

    CMS releases clearer expectations for plans and oversight.

  3. 3

    Enforcement cadence established

    Ongoing

    Audits and sanctions occur with visible follow-through.

  4. 4

    Outcomes tracked against win condition

    Within 24 months (win condition)

    Violations and improper denials decline toward the stated target.

Risks, trade-offs & sources

Updates

No updates yet.

Updates will appear here as the strategy progresses.

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