The Alliance submitted its wound care perspective to CMS' Proposed Policy and Technical Changes to the Medicare Advantage Program  for Contract Year 2027. The Alliance raised concerns regarding how modifications to the Hierarchical Condition Category risk adjustment model could impact for beneficiaries requiring wound care services. Comments also flagged that Medicare Advantage (MA) enrollees with lymphedema are not consistently receiving the coverage to which they are entitled, despite statutory requirements mandating that MA plans provide benefits that are at minimum equivalent to those available under traditional Fee-for-Service Medicare. "Analysis of coverage policies, beneficiary reports, and plan documents across multiple MA plans demonstrates that coverage for lymphedema compression treatment items varies dramatically from plan to plan...Some MA plans have implemented coverage policies that closely mirror FFS Medicare standards, while others have erected substantial barriers that effectively limit beneficiary access to appropriate lymphedema management supplies," the Alliance reported, urging updates.

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