Medicare Advantage plans to see 1.84% rate bump
- Baseline Medicare Advantage payment rates are proposed to increase an average of 1.84% for 2019, CMS announced Thursday. After taking into account the underlying coding trend's impact on risk scores, CMS says payments will increase on average by 3.1% in 2019.
- CMS is also proposing opioid prescribing limits starting in 2019 for Part D plans to help stem the opioid crisis.
- CMS Administrator Seema Verma says the proposed changes will provide "new flexibilities for Medicare Advantage plans to offer new health-related benefits." CMS says one-third of Medicare beneficiaries are enrolled in an MA plan.
And CMS is proposing to make the plans more attractive to recipients.
As part of the proposed changes, CMS said it is redefining health-related supplemental benefits to include coverage for "non-skilled in-home supports, portable wheelchair ramps and other assistive devices and modifications when patients need them."
The agency previously said items would not be eligible as a supplemental benefit if the primary purpose included daily maintenance. CMS now says that it is proposing to allow supplemental benefits "if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization."
Specific ideas CMS is proposing to combat the opioid crisis include: point-of-sale opioid safety edits at 90 morphine milligram equivalent with a seven day supply; implementing supply limits for initial fills of opioids for acute pain; improving the overutilization monitoring system to identify high-risk patients using drugs with an opioid that increase the chances of an adverse event occurring; and technical fixes to the Pharmacy Quality Alliance measures used to evaluate sponsors' efforts to counter the epidemic.
CMS also proposed increasing the percentage of encounter data used to set rates from 15% to 25%. Payers argue encounter information isn’t accurate enough to be widely used, and the GAO has said CMS should do more to validate the data.
CMS says it will be shifting how it calculates Medicare Advantage risk scores from 15% encounter data and 85% Risk Adjustment Processing System (RAPS) data in 2017 and 2018, to 25% encounter data and 75% RAPS data in 2019. The 21st Century Cures Act requires the agency to fully phase in changes to the risk adjustment model by 2022.
"Since the quality of the encounter data has improved, CMS believes it is appropriate to move forward with the proposed increased percentage of encounter data in the blend," the agency said.
The insurer trade group AHIP issued a comment that did not take a firm position on the proposal.
"AHIP will review the advance rate notice carefully to ensure the Medicare Advantage program is protected from policies that could impact the long-term stability of the program," president Marilyn Tavenner said in a statement.
CMS reiterated that MA plans can offer targeted cost sharing for specific populations "based on health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly."
“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” Verma said in a statement. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits."
In January, CMS released Part I of the 2019 Advance Notice, which contained information on proposed changes to the Part C risk adjustment model.
Comments on the proposals in Part I and Part II of the proposed Advanced Notice and the Draft Call letter are due March 5, 2018, CMS said Thursday. CMS plans to publish the final 2019 Rate Announcement and final Call Letter by April 2, 2019.
- Centers for Medicare & Medicaid Services Fact Sheet: 2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter
- Centers for Medicare & Medicaid Services Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 draft Call Letter
- Healthcare Dive CMS proposes Medicare Advantage, drug rebate changes
- Healthcare Dive CMS proposes Medicare Advantage risk adjustment increase
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