Proposal is Accompanied by Significant Revisions to Risk Adjustment Methodologies and Employer/Union-Only Group Welfare Plan BidsThe Advance Notice (“Advance Notice”) of Methodological Changes for Calendar Year (“CY”) 2017 for Medicare Advantage (“MA”) Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter was released by the Centers for Medicare & Medicaid Services (“CMS”) on February 19, 2016.[1] The Advance Notice describes proposed payment and risk adjustment methodology changes for MA and Medicare prescription drug benefit (“Part D”) plans. It also includes CMS’s preliminary estimates of factors that will affect 2017 payments for MA and Part D plans and the Part D and retiree drug program benefit parameters for 2017. The draft Call Letter outlines policy modifications and other considerations for MA and Part D plan sponsors preparing bids for the 2017 contract year.While the Advance Notice may be initially welcomed, thanks to the modest proposed increase in plan payments and the lack of any proposal to limit in-home health assessments, CMS’s proposed updates to the risk adjustment and quality bonus measure models will have varying positive or negative effects on MA and Part D plans, depending on the make-up of the plans’ enrollees. Further, CMS is proposing to… Read full this story
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