The Centers for Medicare & Medicaid Services today announced final 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 3.4%, excluding an expected 3.1% increase in risk scores. CMS finalized changes to the risk adjustment model for aged and disabled beneficiaries enrolled in MA Part C plans beginning in CY 2019, as required by the 21st Century Cures Act, and additional changes to MA and Part D payment policies for CY 2019. CMS must phase in the new risk adjustment model over four years and will use a 25% to 75% blend of the new and previous risk adjustment model for 2019. In addition, the agency will update the MA risk adjustment models for end-stage renal disease plans in 2019, among other changes. However, CMS will not move forward with the proposed changes to the Part D risk adjustment model. The agency also included several changes to combat opioid overuse. AHA will provide more information on the final changes to members soon.

Related News Articles

Headline
Tax-exempt hospitals and health systems provided $95 billion in community benefits in 2016, almost 11 times the value of their federal tax exemption.
Headline
The Department of Health and Human Services aims to release proposed rules amending the physician self-referral (Stark law) regulations and safe-harbors under…
Headline
The House Energy and Commerce Subcommittee on Health today held a hearing on seven bills aimed at improving transparency in the drug supply chain to lower…
Headline
The Department of Health and Human Services Office for Civil Rights today published in the Federal Register its final rule concerning federal health care-…
Headline
The Government Accountability Office yesterday named two new members to the Medicaid and CHIP Payment and Access Commission.
Headline
Despite some progress in transparency related to the process for Section 1115 Medicaid waivers, the Centers for Medicare…