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
Over 1,750 Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs…
Headline
The Centers for Medicare & Medicaid Services April 6 finalized updates and changes to its Medicare Advantage and Part D payment methodologies for calendar…
Headline
The Centers for Medicare & Medicaid Services should develop prior authorization measures for the Medicare Advantage Star Ratings Program to minimize care…
Headline
The Centers for Medicare & Medicaid Services today proposed changes to the Medicare Advantage and Medicare Part D programs, including implementing various…
Headline
The Centers for Medicare & Medicaid Services yesterday announced proposed changes to the risk adjustment model for Medicare Advantage organizations and…
Headline
Medicare Advantage organizations received $6.7 billion in risk adjustment payments in 2017 for diagnoses that were not supported by the medical record,…