Grassley, a member of the Finance Committee, which oversees CMS, expressed concern officials inside the agency may have leaked specific details about the final Medicare Advantage rates. It is part of a larger pattern of government officials providing “special access” to nonpublic financial data to outside financial firms, the senator said.
Grassley had previously raised concerns over CMS' providing nonpublic information to such firms in December 2011 after an agency employee alleged CMS staff had been ordered to participate in a “lengthy” 2009 meeting with one such firm, the Marwood Group. The CMS has never confirmed that such a meeting took place, according to a Republican Senate official.
The senator was “concerned” with the agency's responses to his questions at the time on its measures to control access to health policy information, the staffer said.
On Thursday, Grassley sought a complete list of all administration personnel who had access to the Medicare Advantage rate information, as well as a timeline of decisions on the rate change.
Grassley also plans to reintroduce legislation that would impose disclosure requirements on such firms, which often hire former agency officials and ex-Capitol Hill staffers who worked closely with the agency.
Meanwhile, a CMS spokesman defended the agency's assumption that there would be a congressional fix to the Medicare physician pay formula, which will turn a proposed 2.2% Medicare Advantage cut into a 3.3% rate increase. Current law calls for a 25% cut in physician pay, which affects the overall rates paid to Medicare Advantage plans.
“Given consistent congressional action for over the past decade, the agency is exercising authority to reflect our best estimate of Medicare spending in 2014,” Brian Cook, a CMS spokesman, said in an e-mail.
“This is a specific, unique circumstance and we expect that current law will continue to be used in other instances,” he said about the ongoing SGR cut reversals and the request of members of Congress that HHS Secretary Kathleen Sebelius take that into account when setting the Medicare Advantage rates.
The CMS' April payment policy letter said the switch was justified by the “increasing number of years in a row for which Congress has enacted an SGR fix after the MA rates for the upcoming year have been released in April.”
Agency officials said the justification for the Medicare Advantage reversal was analogous to what it does for its Part B premiums, which cover physician visits. The CMS has specific statutory authority to build in the assumption that Congress will override the cuts in the sustainable growth-rate formula when setting Part B premiums.
In previous years, Medicare didn't do the same for Medicare Advantage because agency officials didn't believe they had the authority. However, the Congressional Research Service issued a March 26 opinion (PDF) that Sebelius had that authority.
