Our Work
MAPA’s goal is to improve MA plan regulatory compliance in order to: 1) ensure the best quality of care for the beneficiary (MA member), and 2) help regulators understand how MA focused rules and regulations affect the ability of a MA plan to deliver services and the best quality of care to its members.
To date, MAPA has provided input, guidance, and recommended solutions to CMS for some of the more complex challenges affecting MA plans. These include but are not limited to:
- Medicare Managed Care Manual refresh and the plethora of additional rules and regulations
- Regulatory audit goals and overlaps
- Criteria for CMS’s five-star quality rating system
- Inconsistency among regional offices regarding application of MA rules and regulations
- Complaint tracking module and resolution
- Grievance and appeals processes, including clinical decision-making
- Formulary administration under Part D
- Benefit requirements
- Rules regarding translations of marketing and member material into different languages
- IT requirements
- Rules for marketing materials
Accomplishments to Date
- MAPA has grown from six members in 2016 to 18 members in 2021 and now represents more than 75% of the 33 million Medicare beneficiaries in the MA program.
- MAPA has become a trusted partner and a source of valuable input for CMS. CMS leaders have told MAPA they have never received the range and detail of feedback and support MAPA members provide.
- After MAPA’s initial engagement, CMS requested quarterly meetings with MAPA, with ad hoc meetings as necessary.
- At CMS’s request, MAPA provided training to CMS staff about how the MA/MAPD plan business model works. MAPA held the initial training conference, called “Getting to Know the Plans,” at CMS’ central office in December of 2019. Approximately 200 CMS staff members attended in person or virtually.
- MAPA was asked by CMS to take the lead in developing a plan to address some of the more onerous marketing issues, including but not limited to false or misleading third party advertising, and to provide best practices and recommendations for better regulation and oversight of multi-carrier call center agencies.
- MAPA sponsored a meeting between CMS’s Chief Medical Officer and MA plan medical directors, to discuss determinations made by the Part C Independent Review Entity (IRE).
- In response to a specific issue, MAPA secured a letter from CMS to beneficiaries explaining why and how the Social Security Administration had not deducted their premiums even though they had signed up for automatic premium withholds.
- MAPA helped to secure the reprioritization of CMS MA plan program audits during the height of the COVID-19 pandemic.
- CMS asked MAPA to report to them on how MA plan beneficiaries and providers were faring during the COVID-19 pandemic. MAPA solicited input from our membership and compiled a detailed report for CMS.
- At the urging of MAPA, CMS’s Office of Financial Management agreed to update their contracts with certified public accounting firms to expand the auditors’ training requirements in the area of MA/MAPD program administration.
- MAPA was featured in a cover article in the March 2017 issue of Health Care Compliance Association magazine as a unique and up-and-coming compliance organization.
- MAPA was featured in a January 2019 video interview conducted by the Health Management Academy.
How to Get Started
Become a Member
Membership in MAPA and annual membership dues are determined by the Board of Directors. Each member has the right to appoint one representative to the Board.