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Policy

Policy

Greater flexibility in allowable supplemental benefits will enable Medicare Advantage to better address the needs of beneficiaries with chronic conditions and social determinants of health that impact health outcomes.

CMS verifies the accuracy of Medicare Advantage payments by conducting Risk Adjustment Data Validation (RADV) audits.

Risk adjustment is an essential mechanism used in health insurance programs to account for the overall health and expected medical costs of each individual enrolled in a health plan. Accurate documentation of diagnoses by clinicians is a critical component of the risk adjustment process.

Introduction

 

This paper analyzes the potential impacts of expanding the choice of Medicare Advantage to all End Stage Renal Disease (ESRD) beneficiaries in Medicare. It concludes that the benefits of Medicare Advantage would only be fully realized for these beneficiaries if the Medicare Advantage ESRD payment system is accurate, which is currently not the case. The analysis includes background information on kidney failure and its treatments, including dialysis, as well as a summary of Medicare ESRD payment policies. Finally, the paper includes recommendations on how to improve ESRD care in Medicare. Recommendations include the expansion of more ESRD beneficiaries in Medicare Advantage to ensure high- quality care and prevent negative effects on the Medicare Advantage program, which 1/3 of beneficiaries rely on for their Medicare.

This issue brief explains the Medicare Advantage (MA) benchmark cap and highlights the consequences for MA beneficiaries. 

Between 2011 and 2030, roughly 10,000 seniors in America will become eligible for Medicare every day, presenting challenges and opportunities for the health care system.1 The growing demand for health care services increases the need for innovative community partnerships enabled by Medicare Advantage (MA).

Community partnerships help seniors age “in place”; outside of traditional health care settings. MA plans and providers are bridging gaps in health care delivery by actively engaging in partnerships with community-based organizations to meet the health and social needs of Medicare beneficiaries to improve outcomes and slow disease progression.

As benefciaries look towards Medicare Advantage (MA) open enrollment in the fall (October 15 – December 7), multiple recent reports and data releases show that the popularity of MA continues to grow. Throughout the country, Medicare benefciaries have access to a variety of MA plans and the quality of these plans is high and getting higher.

Download BMA's primer on the final rate notice here.

On April 4, 2016 the Centers for Medicare & Medicaid Services (CMS) released the 2017 Medicare Advantage Final Rate Notice and Call Letter that can be viewed here. Below is a summary of the key issues Better Medicare Alliance (BMA) raised in response to the Advance Rate Notice, released in February, and the policies finalized in the Final Rate Notice.

This issue brief highlights the consequences of the CMS proposed policy change to over 3 million beneficiaries in MA retiree coverage.

PROPOSED CHANGES TO RETIREE COVERAGE

Medicare Advantage (MA) employer plans, officially known as Employer-Group Waiver Plans (EGWPs), allow employers, governments, and labor unions to provide comprehensive MA coverage to their retirees. MA employer plans provide Medicare Part A and B benefits, as well as supplemental benefits. 

These plans offer benefits tailored to specific groups of retirees, which are then available wherever the beneficiary may live. Employer-sponsored MA plans have successfully enabled millions of retirees nationwide to maintain consistent benefits and contain costs for industries, governments, and beneficiaries. CMS is proposing to move from a bidding system to a fixed payment system for this retiree coverage. The new system would be based on a methodology that fails to capture the differences between plans sponsored by employers for groups of retirees and those offered to individuals.

On February 19, 2016 the Centers for Medicare & Medicaid (CMS) released the Medicare Advantage (MA) 2017 Advance Notice, sometimes called the “45 Day Notice,” which includes methodological changes for calendar year 2017 for MA capitation rates, payment policies (for MA and Part D), as well as other policies and information in what’s called the “Call Letter.” The Final Notice will be released 45 days after the Advance Notice, on April 4, 2016. This primer summarizes key elements in the 2017 Advance Notice for our Better Medicare Alliance (BMA) allies.

Better Medicare Alliance presents the paper, “Understanding Risk Adjustment in Medicare Advantage.” Medicare Advantage relies on accurate and stable risk adjustment that ensures plans and practitioners are able to provide high value care to all beneficiaries, including those with complex health needs.

With the high and growing prevalence of Type 2 diabetes among Medicare beneficiaries, cost effective diabetes prevention, treatment and management are essential to the future of the Medicare program.  Approximately one-quarter of the Medicare population has Type 2 diabetes, with estimates ranging from 24 to 31 percent depending on whether Medicare claims data are used or self-reported data are

The Medicare Advantage program is committed to promoting the appropriate use of Medicare preventive benefits. Medicare Advantage plans cover a broad range of services to prevent disease and detect disease early when it is most treatable and curable, as well as manage disease so that complications and higher costs can be avoided.