Stakeholders back CMS plan to phase in risk adjustment over 3 years

Stakeholders back CMS plan to phase in risk adjustment over 3 years

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Health insurers and stakeholders have voiced support for the Centers for Medicare and Medicaid Services’ plan to phase in the risk adjustment model changes over three years, into the 2024 Medicare Advantage program and Medicare payment policies. part D released Friday.

Model changes will begin in 2024, with the full weight of progressive risk adjustment taking effect in 2026, according to Susan Dentzer, president and CEO of America’s Physician Groups.

“We’re happy with that,” said Susan Dentzer, president and CEO of America’s Physician Groups. “They mostly listened.”

Insurers also voiced support for increased payments in the 2024 Medicare Advantage and Part D rate announcement.

CMS plans a payment increase for Medicare Advantage plans by 3.32% from 2023 to 2024 following various changes, including in risk adjustment.
This compares to the 1.03% revenue increase proposed in the 2024 notice. released in February.

“We appreciate CMS acknowledging serious concerns about several proposed policies in the Advance Rate Notice that would affect MA enrollees in 2024, including phasing in the changes over a three-year period,” said Matt Eyles, President and CEO of AHIP. “As the MA program continues to serve a growing share of Medicare-eligible Americans, it is critical that the public sector and the private market work in partnership, considering the perspective of all stakeholders and the impact of new changes to the Medicare Advantage program in a thoughtful, collaborative, and timely manner. A large bipartisan group of congressional champions and other stakeholders have come forward to demonstrate their strong support for beneficiaries and for this program, which provides consistently providing affordable, high-quality care to millions of Americans.

Better Medicare Alliance also said it appreciates the phased approach, but remains concerned that the underlying policy remains unchanged.

“Better Medicare Alliance will continue to analyze the impact of the final rate announcement, particularly on low-income beneficiaries, eligible dual enrollees, and vulnerable populations,” said Mary Beth Donahue, President and CEO. of the Better Medicare Alliance.

Margaret A. Murray, CEO of the Association for Community Available Plans, said, “Notably, the rule staggers over more than three years significant changes to its risk adjustment model, which measures the relative health of enrollees at a plan and affects health plan payment rates. ACAP will closely monitor the impact of this change to the risk adjustment system on the dual eligibility beneficiaries our plans serve, continue our constructive conversations with CMS to review these impacts, and work to mitigate any unintended consequences. that these changes to the payment system might have. coverage available to all of Medicare’s most vulnerable enrollees. »


What CMS had proposed were dramatic changes in risk adjustment, Dentzer said.

“They really pushed this through, quickly. They fully recognized in the actions that bringing this degree of change was not going to work,” she said. “He was not sensitive to stakeholders.”

The finalized risk adjustment model reflects revisions focused on conditions that are subject to more coding variation.

20 codes in particular are believed to be problematic, Denzer said.

“It was ill-advised and too quick,” she said.


CMS has released technical and clinical updates to the MA Risk Adjustment Model to keep it current and improve payout accuracy.

One change allowed for the transition to the Internal Classification of Diseases (ICD)-10 system, which is the coding classification system used throughout the US healthcare system since 2015, and updated years of data.

CMS also said it would begin recovering improper payments made to insurance companies in Medicare Advantage. Proposed policies include: cracking down on abusive and confusing marketing programs; address problematic pre-authorization practices that prevent timely access to needed care; facilitating access to life-saving behavioral health care; and raise the bar for quality and drive towards more equitable care.

Twitter: @SusanJMorse
Email the author: [email protected]

Juan Nanez will offer more details during the HIMSS23 session “How Healthcare Provider Access to Regional Data Reduces Hospital Readmissions”. It’s scheduled for Tuesday, April 18 from 11-11:30 a.m. CT at the South Building, Level 1, Room S104.

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