CMS Finalizes Medicare Advantage 2024 Rate Notice

The Centers for Medicare and Medicaid Services announced Friday improvements to the system used to pay for Medicare Advantage plans.

CMS estimates that health insurers covering Medicare Advantage enrollees will see a 3.32% net increase in revenue from the program in 2024, up from the 1% projected in one. draft version of rate notice, thanks to the three-year phased-in risk-adjustment program revisions. The base rate would drop by 1.12%, not taking into account how insurers code for members’ health conditions. Insurers described the earlier iteration of the policy as a blow to the increasingly popular program that would force them to reduce benefits.

The health insurance industry’s primary concern is CMS’s approach to the risk adjustment program, which carriers use to measure and report members’ health status to the agency. Insurers who cover sick policyholders receive higher payments. Critics say this creates an incentive for Medicare Advantage plans to exaggerate the health conditions of their policyholders and log more and more risk codes to inflate payouts.

Some insurers further argue that risk-adjustment changes exceed the statutory reach of CMS. CMS Administrator Chiquita Brooks-Lasur insisted the agency was within its legal authority and denied cutting benefits from the new Medicare Advantage policies. “We expect premiums and plan benefits to be in line with them,” Brooks-Lasur said during a news conference Friday. “What’s different are the choices that are planning.”

Despite CMS describing the 2024 rates as a net increase, the insurance industry sees things differently. when combined with the results of a different move to make Star rating bonus is hard to earnAccording to the industry, Medicare Advantage carriers will face a net reduction in payments next year. CMS tightens star rating program after another Record number of insurers receive bonus Last year during the COVID-19 pandemic, a trend that reversed this year,

CMS will eliminate more than 2,200 risk codes, which it claims are most responsible for upcoding. The agency will use a mix of the existing risk adjustment model and one-third of the new model next year, then the remainder of the revised risk coding process over the next two years. In addition, CMS will consolidate codes associated with certain medical conditions, such as diabetes and depression, and retain only those that reliably estimate future costs.

“To be clear, CMS is still paying higher for MA plans for beneficiaries with sicker and more complex conditions,” Dr. Meena Seshamani, director of the Centers for Medicare, said during the news conference.

Wesley Sanders of Evenson Consulting, formerly chief financial officer at Alliant Health Plans, said insurers oppose the risk-adjustment provisions and will lobby Congress to reverse them. But the health care industry may face skeptical lawmakers amid ongoing Justice Department cases accusing Medicare Advantage carriers of overpayments and regulatory efforts to rein in unfair marketing tactics. “There is no such support on the plans [Capitol] Hill that used to be near them,” he said.

Sanders said giving insurers three years to adapt to the revised risk adjustment policy gives them time to adjust their operations to maximize profitability.

Health insurance trade group AHIP did not comment on the substance of the rate notice. “We are committed to working collaboratively with the administration, as well as members of Congress, to continue building on the strengths of this program and ensuring that it continues to provide better services, better access to care.” and better value for seniors and taxpayers, President and CEO Matt Isles said in a news release. The Better Medicare Alliance is also wary of the risk adjustment policy, a coalition of insurers, providers and patient advocates, said in a news release.

The Blue Cross Blue Shield Association expressed concerns about “modest” benchmark payment increases and risk adjustment provisions to insurers. “Substantial growth rates and measured risk-adjustment model changes are necessary to ensure strong MA programs,” David Merritt, senior vice president for policy and advocacy, said in a news release.

The Alliance of Community Health Plans, which represents nonprofit insurers, characterized the new risk adjustment policy as a positive development and called on CMS to be more transparent about its actuarial estimates of how insurers assign patient risk. how to code “This information is important for showing significant differences between MA plans for targeting aggressive behavior,” the trade group said in a news release.

Medicare Advantage insurers will generate an estimated $17 billion in overpayments in 2021, according to the most recent data from the Medicare Payment Advisory Commission, which makes policy recommendations to Congress. CMS announced last month that it would recover $4.7 billion Over 10 years the agency concluded that Medicare Advantage was overpaid to insurers. CMS also reduced benchmark payments by eliminating payments for indirect medical education expenses to Medicare Advantage insurers.

Source link

Leave a Comment