By Virgil Dickson | February 1,
2018
The CMS Thursday proposed to bump up baseline Medicare Advantage
payment rates for 2019 by 1.84% on average, up from the 0.45% plans received
last year.
The average Medicare Advantage payment rate will increase by 3.1% after taking into account the way health plans code their members' diagnoses, the CMS said. That's up from a 2.95% increase last year.
The CMS will also move ahead with plans to increase the use of encounter data, or information about the care an enrollee received from a provider, to determine risk scores for plans.
In the proposed notice, the agency suggested that 75% of Medicare Advantage risk scores are based on traditional fee-for-service data and 25% are based on encounter data.
That differs from 2018, when the agency used a risk score blend of 85% of fee-for-service data and 15% of the encounter data in 2018.
Stakeholders such as the American Hospital Association have pushed back at using encounter data after a January 2017 Government Accountability Office report found such data is often not accurate.
"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 in a release Thursday.
The insurance industry may be dismayed by another proposed change. In 2016, the CMS suggested terminating the bidding process for employers and unions that offer Medicare Advantage plans to their retirees, also known as "employer group waiver plans," or EGWPs.
Instead, those plans would receive a lump-sum payment based on county-level individual bids that would have lowered plan revenue.
AHIP had said the policy had the potential to disrupt care for the more than 3.6 million beneficiaries enrolled in these plans.
While the move was delayed in the final 2017 and 2018 notices, the CMS now proposed to complete the transition to county benchmark rates for retiree plans in 2019.
The agency previously said it would phase in the policy over a two-year period, with half of employer Advantage plan payments being based on their own bids and half on county benchmarks.
The CMS will accept comments on the proposals through March 5 and release the final 2019 rates by April 2.
Medicare Advantage enrollment is projected to grow by 9% to 20.4 million in 2018. The CMS estimated that more than one-third of all Medicare enrollees, or 34%, will be in a Medicare Advantage plan in 2018.
The average Medicare Advantage payment rate will increase by 3.1% after taking into account the way health plans code their members' diagnoses, the CMS said. That's up from a 2.95% increase last year.
The CMS will also move ahead with plans to increase the use of encounter data, or information about the care an enrollee received from a provider, to determine risk scores for plans.
In the proposed notice, the agency suggested that 75% of Medicare Advantage risk scores are based on traditional fee-for-service data and 25% are based on encounter data.
That differs from 2018, when the agency used a risk score blend of 85% of fee-for-service data and 15% of the encounter data in 2018.
Stakeholders such as the American Hospital Association have pushed back at using encounter data after a January 2017 Government Accountability Office report found such data is often not accurate.
"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 in a release Thursday.
The insurance industry may be dismayed by another proposed change. In 2016, the CMS suggested terminating the bidding process for employers and unions that offer Medicare Advantage plans to their retirees, also known as "employer group waiver plans," or EGWPs.
Instead, those plans would receive a lump-sum payment based on county-level individual bids that would have lowered plan revenue.
AHIP had said the policy had the potential to disrupt care for the more than 3.6 million beneficiaries enrolled in these plans.
While the move was delayed in the final 2017 and 2018 notices, the CMS now proposed to complete the transition to county benchmark rates for retiree plans in 2019.
The agency previously said it would phase in the policy over a two-year period, with half of employer Advantage plan payments being based on their own bids and half on county benchmarks.
The CMS will accept comments on the proposals through March 5 and release the final 2019 rates by April 2.
Medicare Advantage enrollment is projected to grow by 9% to 20.4 million in 2018. The CMS estimated that more than one-third of all Medicare enrollees, or 34%, will be in a Medicare Advantage plan in 2018.
Virgil Dickson reports from Washington on the
federal regulatory agencies. His experience before joining Modern Healthcare in
2013 includes serving as the Washington-based correspondent for PRWeek and as
an editor/reporter for FDA News. Dickson earned a bachelor's degree from DePaul
University in 2007.
No comments:
Post a Comment