CMS proposes 2019 risk adjustment changes for MA Part C plans

The Centers for Medicare & Medicaid Services last week announced proposed changes to the risk adjustment model for aged and disabled beneficiaries enrolled in Medicare Advantage Part C plans beginning in calendar year 2019, as required by the 21st Century Cures Act. CMS proposes phasing in the changes over four years. For 2019, the agency proposes adding mental health, substance use disorder and chronic kidney disease conditions to the risk adjustment model and taking into account the number of conditions that a beneficiary has under the payment model. The advance notice also discusses an alternative risk adjustment model that would take into account all conditions that a beneficiary has, including those outside the payment model. CMS projects the proposed risk adjustment model would increase MA risk scores by 1.1% and result in less payment variance across MA contracts, while the alternative model would decrease risk scores by 0.28% and result in greater payment variance across plans. The proposed model also would make technical updates to the risk adjustment data. CMS will accept comments on the advance notice through March 2, and expects to propose changes to other MA payment methodologies for 2019 in a separate advance notice.