Announcing Our Medicare Appeal FOIA Request

Today we are submitting two Freedom of Information Act (FOIA) requests to the Centers for Medicare and Medicaid Services (CMS).

The requested information will inform comparisons between traditional Medicare and Medicare Advantage. It will also inform more broad questions about equity in Medicare administration.

This work is a collaboration with Jeremy Singer-Vine from the Data Liberation Project.

Background

We identified the need for appeal data from traditional Medicare in our analysis of Medicare Advantage appeals. CMS maintains a public database of Level 2 appeals for Part C and Part D claims, but not for Part A and Part B claims. Comparable data for all Medicare parts ought to be public.

The Requests

In collaboration with the Data Liberation Project, we are making two FOIA requests. The requests cover three things:

• Documentation for the Medicare Appeals System. The Medicare Appeals System (MAS)¹ is the primary system used to track appeals in Medicare.

  CMS introduced the system in 2005, and has since expanded its capability and scope. It is currently the system of record for use in Level 2 appeals across all Medicare parts. We are requesting documentation for the technical specifications of this system. This includes, for example, schema for all relational databases involved in the system.

• Level 2 Appeals for Part C and Part D. Historical records for anonymized Level 2 appeal outcomes for parts C and D dating back to 2015. The Level 2 appeal database that CMS hosts for Part C and Part D only goes back to 2020. We are requesting all such data produced in or after 2015.

• Level 2 Appeals for Part A and Part B. The existing Level 2 appeal database only contains appeals from Part C and Part D. We are requesting Level 2 appeal outcomes for Part A and Part B appeals dating back to 2015. Such data would support direct comparison of one shared aspect of all Medicare parts.

This request is a step toward direct comparisons of appeals across Medicare parts. Fulfillment would empower citizens, advocates, journalists, lawmakers, and regulators. It would yield an unprecedented ability to measure adjudication differences between Medicare parts. Such differences have serious implications for the most vulnerable.

We expect to submit additional requests for more subsets of Medicare appeal data. Data provided in response to these requests will inform subsequent requests.

Acknowledgements

This is joint work with the Data Liberation Project, an initiative to identify, obtain, reformat, clean, document, publish, and disseminate government datasets of public interest. If you're not familiar, they do fantastic work that we highly recommend checking out.

We are grateful to numerous staff at CMS with whom we conversed, and who graciosly responded to our requests for input prior to our formal submission of a request. We hope to continue to build a fruitful working relationship with CMS staff to help ensure public access to crucial information.

Learn More

You can read more details about our FOIA request, or read them in full, at either of the following two locations:

• Data Liberation Project's Requests Log.
• Persius' Public Records Portal.

Please direct correspondence with questions, suggestions, or other feedback to info@persius.org.