CMS Proposes Additional 2019 Payment Changes for MA, Part D Plans

The Centers for Medicare & Medicaid Services yesterday announced additional proposed changes to Medicare Advantage and Part D payment policies for calendar year 2019. CMS anticipates the MA plans and Part D sponsors will see an average revenue increase of 1.84%, excluding an expected 3.1% increase in risk scores. In December, CMS proposed changes to the risk adjustment model for aged and disabled beneficiaries enrolled in MA Part C plans beginning in calendar year 2019, as required by the 21st Century Cures Act. CMS must phase in the new risk adjustment model over four years and proposes using a 25% to 75% blend of the new and previous risk adjustment model for 2019. The agency also proposes to update the MA risk adjustment models for end-stage renal disease and Part D plans in 2019, among other changes. In addition, CMS proposes several changes to combat opioid overuse, including adding hard safety edits at the point-of-sale that limit supply to seven days. AHA will provide more information on the proposed changes to members soon. CMS will accept comments on the new notice through March 5 and on the December notice through March 2, and expects to publish final notices on April 2.