The Centers for Medicare & Medicaid Services yesterday announced proposed changes to the risk adjustment model for aged and disabled beneficiaries enrolled in Medicare Advantage Part C plans beginning in calendar year 2020, as required by the 21st Century Cures Act. CMS proposes to implement the risk adjustment model proposed but not finalized in the 2019 rate announcement, which takes into account the number of conditions a beneficiary has. The advance notice also seeks comments on an alternative risk adjustment model that includes additional condition categories for pressure ulcers and dementia. CMS proposes to phase in the changes over three years. The agency will accept comments on the advance notice through Feb. 19, and expects to propose changes to other MA payment methodologies for 2020 in a separate advance notice. In addition, CMS yesterday released its first report to Congress on risk adjustment in the MA program, as required by the 21st Century Cures Act.

Related News Articles

Headline
The AHA Sept. 15 expressed support for the Ensuring Access to Essential Providers Act, legislation that would require Medicare Advantage plans to cover…
Headline
The AHA Sept. 15 urged Aetna to rescind its recently announced “level of severity inpatient payment” policy, saying that it “could erode the transparency…
Headline
A JAMA internal medicine study published Sept. 8 found that since the COVID-19 pandemic, Medicare Advantage beneficiaries have been experiencing longer…
Headline
A Health Affairs study published Sept. 2 found that less than 40% of Medicare beneficiaries with opioid use disorder received standard care in alignment with…
Headline
The Department of Health and Human Services and the Centers for Medicare & Medicaid Services Aug. 21 announced the creation of a Healthcare Advisory…
Headline
A JAMA study published Aug. 18 found that plan design changes by Medicare Part D insurers, particularly for Medicare Advantage plans, following passage of the…