CMS Directs Medicare Advantage Plans to Submit Utilization Data on Hearing Benefits

Medicare Advantage plans are required to submit detailed, service-level utilization data to Centers for Medicare and Medicaid Services (CMS). These data—known as encounter data—are technically supposed to include information on supplemental (hearing, vision, and dental) benefits. However, in a recent study, the Government Accountability Office found that information submitted by plans on enrollees’ use of supplemental benefits is limited because CMS guidance does not specifically mention the submission of data for supplemental benefits and there are certain challenges associated with collecting and submitting encounter data for certain supplemental benefits.

On February 21, 2024, CMS sent the following directive to all Medicare Advantage plans, clarifying that they are required to submit encounter data on supplemental benefits, and provided instructions on how to do so. They also clarify that additional guidance will be forthcoming.