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BETTER MEDICARE ALLIANCE STATEMENT ON PROPOSED POLICY CHANGES TO MEDICARE ADVANTAGE

February 22, 2016

FOR IMMEDIATE RELEASE

Contact: Adjoa Adofo, 202-735-0676

aadofo@bettermedicarealliance.org

 

Washington, D.C. (February 22, 2016) – Better Medicare Alliance (BMA) President and CEO Allyson Y. Schwartz released the following statement in response to proposed policy changes in the CY2017 preliminary Medicare Advantage (MA) Advance Notice and Call Letter released by the Centers for Medicare and Medicaid Services (CMS):

“On behalf of a broad coalition of nurses, doctors, plans, employers, retiree organizations, and beneficiaries who support Medicare Advantage, Better Medicare Alliance looks forward to submitting full comments after careful analysis and assessment of potential effects of the proposed changes on plans, providers, and beneficiaries, as well as impact on shared goals to provide high quality, affordable, value-based care. 

The 2017 Advance Notice acknowledges success of Medicare Advantage plans in offering quality care to Medicare beneficiaries and moving to value-based care. In addition, CMS’ willingness to provide early release of possible adjustments and changes gave the opportunity for public feedback prior to the Advance Notice and Call Letter that improved the proposed policy changes.

However, initial review of the proposal reveals three specific areas that warrant concern and require further analysis. These are changes that impact employer group retirees’ access to Medicare Advantage, changes to the use of encounter data, and changes that may impact quality for beneficiaries who are dually eligible for Medicare and Medicaid.”

Medicare Advantage Employer Plans

“CMS has proposed significant changes to Medicare Advantage Employer Group Waiver Plans (EGWPs), which now enable employers to offer their retirees access to MA plans. Across the country, three million retirees are in MA plans that enable access to quality, affordable, and comprehensive care.

A growing number of employers, including state and local governments, businesses, and labor unions are turning to Medicare Advantage to provide quality health coverage with out-of-pocket cost protections for retirees. EGWPs have proven to be an affordable way to provide care coordination, disease management and enhanced benefits for Medicare-eligible retirees that are not available in Fee-for-Service.

Our coalition is concerned that the proposed changes do not take into account the unique character of design and market of employer-based MA and will result in a reduction in payments for EGWPs. Access to this important option for retirees could be stymied if employer’s ability to adequately cover retired employees is impacted. BMA asks that CMS provide additional information on the analysis they used for these changes. BMA will look to ensure that this proposal does prevent disruption in retiree access to MA plans.”

Medicare-Medicaid Dual Eligible Individuals

“CMS has proposed changes to Medicare risk adjustment for individuals who are dually eligible for Medicare and Medicaid to better account for demographics, socioeconomic status, and burden of disease. We support CMS’ goal to ensure an accurate payment model, however, we will continue to evaluate the impact of the changes to the model.

CMS also proposes changes to the accountability for quality care for dual eligible beneficiaries under Medicare Advantage. While the goal is worthy, it is important that the resulting changes do not diminish the quality of plans chosen by dual eligible beneficiaries. The Star Rating methodology effectively supports quality improvement for MA beneficiaries. All beneficiaries, including low-income and those with disabilities, should be able to expect plans to achieve high quality, specifically 4 and 5 Star Rated plans.”

Increased Use of Encounter Data

“CMS has been moving towards greater use of encounter data. The Advance Notice proposes to move from 10% use of encounter data to 50% use of encounter data. This is a significant change to make within a year for a mechanism that may not be fully tested and operational. Feedback from providers, especially clinicians, is essential to ensure a fully operational and reliable new system. BMA calls on CMS to take steps to ensure the transition towards encounter data is smooth and transparent.

BMA looks forward to providing input on the full impact of these proposals during the comment period and continuing a constructive dialogue with CMS, Congress and other stakeholders to further ensure access and quality care for more than 17 million seniors and people with disabilities who depend on Medicare Advantage.”

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Better Medicare Alliance | The Better Medicare Alliance (BMA) is the leading coalition of nurses, doctors, health plans, employers, aging service agencies, advocates, retiree organizations, and beneficiaries supporting Medicare Advantage. Medicare Advantage offers quality, affordability and simplicity, with enhanced benefits to more than 17 million Medicare beneficiaries across America. BMA works to ensure the sustainability and stability of Medicare Advantage through information, research, education, and united support among stakeholders to strengthen this important coverage for seniors and people with disabilities. For more information please visit www.bettermedicarealliance.org.