CMS finalizes 2021 payment changes for MA, Part D plans

The Centers for Medicare & Medicaid Services April 6 finalized updates and changes to its Medicare Advantage and Part D payment methodologies for calendar years 2021 and 2022. The final rate announcement phases in changes to the risk adjustment model required between CYs 2019 and 2022 by the 21st Century Cures Act of 2016, including CMS’ proposal to calculate 75% of the risk score for CY 2021 based on encounter data and 25% of the score based on Risk Adjustment Processing System data, among other policy changes. The agency expects MA plans and Part D sponsors to see an average revenue increase of 1.66% under the final changes, excluding an average 3.56% increase in risk scores.

In detailed comments this week, AHA expressed concern with several CMS proposals to loosen network adequacy standards.