Medicare Advantage (MA) and Medicare Part D plans should expect, on average, a larger revenue increase—0.45 percent—under the 2018 final payment rates than the 0.25 percent increase from the advance notice. CMS released the 2018 Rate Announcement and Call Letter finalizing updates to the methodologies used to pay MA plans and Part D sponsors, which determined that after accounting for expected growth in coding acuity, plans can expect a total change of 2.95 percent in revenue. Higher updates are available to plans that improve the quality of care delivered to enrollees.
The final policies are similar to those from the advance notice (see 2018 payment methodologies for MA and Part D plans proposed, February 2, 2017), but CMS adjusted the risk score blend in response to stakeholder comments. The agency also noted that MA organizations and Part D sponsors should be addressing the opioid crisis, and expects Part D sponsors to improve coordination of care among beneficiaries using high dosage of opioids. CMS also suggested that MA plans with prescription drug coverage consider expanding enrollees’ care management options.
In addition to the Call Letter, CMS requested ideas for regulatory, sub-regulatory, policy, practice, and procedural changes to better accomplish transparency, flexibility, program simplification and innovation in MA and Part D. The agency specifically requested "clear and concise proposals," and, if the ideas involve novel legal questions, an accompanying analysis of CMS’ authority. Comments will be accepted through April 24, 2017.
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