In a December 16 memo to all Medicare Advantage (MA) organizations, the Centers for Medicare & Medicaid Services (CMS) said it will conduct a voluntary pilot, collecting data from a select number of MA plans in 2026 before rolling the program out to all plans in 2027.
The data collection will focus on information related to MA plans initial coverage decisions and plan processed appeals. The pilot aims to support a pledge made by health insurers to streamline and improve the prior authorization process by cutting red tape, accelerating care decisions, and enhancing transparency for patients and providers.
Gerard Mulcahy, director, Medicare Enrollment and Appeals Group, Center for Medicare, said in the memo that the pilot will allow the agency to gather lessons learned and ensure efficient and accurate reporting of data before expanding the collection to all plans in 2027.
Pilot participants will have six months to prepare for the first data submission estimated in late 2026. The experience and feedback of pilot plans will help CMS to shape the data collection effort moving forward, Mulcahy said.
Plans interested in participating in the pilot should email the Part C Appeals and Grievances resource portal by January 9, 2026.