Tag: Medicare Advantage

America’s Physician Groups Responds to CMS MA 2020 Advance Notice

In a comment letter submitted to the Centers for Medicare & Medicaid Services (CMS), America’s Physician Groups (APG) applauded the Agency for its work to help strengthen and protect Medicare Advantage (MA) on behalf of the millions of beneficiaries it serves while also noting specific areas of concern with the recently released MA 2020 Advance Notice and Call Letter.

Don Crane

“MA it is a critical component in transforming our nation’s healthcare system from volume to value-based,” said Don Crane, APG president and CEO. “Numerous studies show that despite a higher proportion of clinical and social risk factors, MA beneficiaries have better health outcomes than their peers in traditional Medicare. A strong rate notice is central to supporting this important program and improving our nation’s healthcare system overall.”

APG applauded the Agency’s work to expand supplemental benefits in MA and better address the opioid crisis through certain targeted services and cost-sharing reductions, but expressed concern with the rate adjustment itself, issues related to MA benchmarking, and the implementation of the transition from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS).

The letter closes by highlighting APG’s support for policies in MA which incent plans and providers to participate in risk-bearing models and called for CMS to extend the 5 percent advanced alternative payment bonus to qualified MA providers as a standalone threshold.

“The 5 percent bonus will level the playing field between providers taking risk in MA and those in traditional Medicare,” said Crane.  “This will allow greater opportunities and incentives for risk-contracting in MA and will advance the Medicare delivery system for all seniors.”

Please click here for a copy of APG’s comment letter.

CMS Moves to “Modernize” Medicaid Plans

Ken Perez
Ken Perez

Guest post by Ken Perez, vice president of healthcare policy, Omnicell.

Since the passage of the Patient Protection and Affordable Care Act, most of the health reform activity in the Medicaid arena has primarily been about expansion of coverage. According to the Centers for Medicare and Medicaid Services (CMS), as of February 2015, 70.5 million people—more than one in every five Americans—were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), which represents an increase of almost 40 percent from the number enrolled at the end of 2009.

However, on May 26, CMS aimed its sights on improving the quality of care delivered by Medicaid, issuing a 653-page proposed rule to “modernize the Medicaid managed care regulations,” which have not been revised in a decade. The proposed rule faces a public comment period that will continue thru July 27.

The changes presented in the proposed rule would align the regulations governing Medicaid managed care with those of other major sources of coverage, including Medicare Advantage (MA) plans and Qualified Health Plans (QHPs), which are offered thru health insurance exchanges (marketplaces). CMS has said that the proposed Medicaid measures will emphasize evaluating health outcomes and the patient experience enrollees have with private plans. In addition, the proposed rule mandates public reporting of information on quality of care, as well as the use of financial incentives to reward Medicaid managed care plans that meet quality measures, a la Medicare Advantage Star Ratings.

CMS’s announcement has been met with mostly favorable responses. “It was about time for the changes” has been a common refrain, with the revisions viewed as a natural, logical progression.

How big is the market that will be impacted by the changes? Per CMS, Medicaid managed care organizations (MCOs) have grown from handling 8 percent of Medicaid beneficiaries in 1992 to about 70 percent of the 70 million Medicaid enrollees today—almost 50 million people. That figure compares with 17.3 million MA enrollees as of January 2015.

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