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.
Special Bulletin on CMS’s Nov. 26 proposed rule aimed at lowering drug prices for beneficiaries enrolled in Medicare Advantage and Part D programs.
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