The proposed 2024 adjustments just begin to address the vast subsidies provided to MA plans through the risk adjustment system and inflated MA benchmarks. Gilfillan and his allies stated that “The CMS proposal projects a 1-percent increase in MA payments in 2024 on top of the 8.5-percent increase projected for 2023. He and the collaborative of healthcare leaders allied with him published a press release that inveighed against a major increase in Medicare Advantage reimbursement. We remain focused on strengthening and improving Medicare Advantage and urge the Administration to pull back its flawed payment model revisions for 2024 and work with health insurance providers and other stakeholders to ensure MA is able to continue providing innovative, high-quality care to enrollees.”īut Rick Gilfillan, M.D., who during 2010-2013 served as the first Director of the Center for Medicare and Medicaid Services (CMMI) in the Obama administration, has gathered together a coalition of healthcare leaders who believe that CMS should keep any pay increases in MA to a minimum. These lower-income enrollees are more likely to have multiple chronic illnesses and complex care needs. “It also brings forward new data and research that shows how these cuts will specifically and significantly impact Americans who are ‘dual eligibles’ and qualify for both Medicare and Medicaid.
“Our comment letter reiterates our serious concerns that CMS’ proposals would increase costs and reduce benefits in 2024 for tens of millions of seniors and people with disabilities,” Eyles said in the statement. On March 6, AHIP released a statement attributed to Matt Eyles, the president and CEO of the association, which represents most of the commercial health plans operating in the U.S. Health plans and some provider associations whose medical groups participate in MA are complaining that the increase is simply insufficient given operating cost increases. And therein lies the controversy, as partisans on the two sides of the policy divide see either excessive spending on Medicare Advantage, or reimbursement that inadequately reflects the population health management and care management work that providers put into caring for health plan members in MA contracts. Agency officials also want to try to make risk adjustment a more predictable process. CMS officials believe that the new risk adjustment model will better reflect current costs associated with specific diseases and conditions. But the agency has also estimated a 3.12% decline in payments after taking in changes to the risk adjustment model.Īn important change in the agency’s proposed rule will be to shift from the ICD-9 system to ICD-10. CMS is expecting an effective growth rate of 2.09% and a 3.3% increase based on the MA risk score trend, which is the average increase in plan risk scores. “The commonsense proposals in the Advance Notice, coupled with the proposals in the MA and Part D rule released in December, ensure these important programs continue to meet the healthcare needs of all beneficiaries,” said CMS Deputy Administrator and Director of Medicare Meena Seshamani, M.D., Ph.D., in a statement on Feb. The proposed rule implements several changes to the risk adjustment model. Last month, CMS officials released the advance notice of methodological changes for MA capitation rates and payment policies for MA and Part D. CMS officials are looking at a potential 1.03-percent average Medicare Advantage revenue increase for calendar year 2024, driven by a 2.09-percent growth rate, representing a major decrease from the 8.5-percent increase in MA rates that CMS had approved in the final rule the agency had released last April. Controversy has erupted in the healthcare industry over the potential decision of officials at the Centers for Medicare and Medicaid Services (CMS) to implement payment and regulatory changes to the Medicare Advantage program.
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