The Medical Imaging & Technology Alliance (MITA)—the association representing manufacturers of medical imaging equipment, radiopharmaceuticals, contrast media, and focused ultrasound therapeutic devices—has submitted comments in response to the Centers for Medicare and Medicaid Services (CMS) request for information on various aspects of the Medicare Advantage (MA) program, including input for ways to advance health equity, expand access to coverage and care, drive innovation to promote person-centered care, and support affordability and sustainability.
“MITA member companies are leading the way on innovations to improve screening, staging, evaluating, managing, and effectively treating patients with cancer, heart disease, neurological degeneration, COVID-19, and numerous other medical conditions, but access to these innovations can face hurdles in some existing MA plans,” says Patrick Hope, executive director of MITA. “We recommend that CMS exert greater oversight over MA plans to ensure that Medicare beneficiaries are receiving the reasonable and necessary care they need when they need it.”
The letter highlighted an April 2022 report from the Office of the Inspector General, which raised concern that certain MA plans impeded beneficiary access to reasonable and necessary care. One tactic of concern mentioned was prior authorization, which creates an administrative burden for providers and patients and can lead to delay or denial of care. Particularly concerning is that advanced imaging services—including MRI and CT—are among the most commonly denied requests for prior authorization by MA plans, potentially resulting in a missed or delayed diagnosis.
Comments also address that MA plans often substitute their own more restrictive commercial plan coverage policies that deny Medicare beneficiaries access to the same items and services that would be available to patients under traditional fee for service (FFS) Medicare Parts A and B.
“We appreciate the opportunity to provide comments and work with CMS to improve MA and ensure patients are receiving reasonable and necessary care in a timely manner,” Hope noted.
To read MITA’s full comments, click here.