CMS proposes 2020 risk adjustment changes for MA Part C plans

Dec 21, 2018 - 02:55 PM
CMS

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.

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