The Centers for Medicare and Medicaid Services, or CMS, announced last week its final program changes for both the Medicare Advantage and Part D Prescription Drug Programs. It says the changes reflect “fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations.”
Andy Slavitt, acting CMS Administrator, explains, “These policies strengthen Medicare Advantage for current and future consumers by encouraging higher quality care. As the Medicare Advantage marketplace continues to grow, 
consumers are getting access to better care through more choice and competition. Seniors and people with disabilities, including the dual-eligible population, will continue to have an extensive choice of plans, affordable premiums, and better and more transparent information about provider networks and pharmacies.”
These two specific programs have seen vast growth and big improvements over the years. Passage of the Affordable Care Act further enhanced each. Medicare Advantage has reached record high enrollment each year since 2010, a trend that’s continuing this year with a cumulative increase of more than 40 percent. Meanwhile, premiums have fallen by close to 6 percent between 2010 and 2015. More than 90 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.
This latest update is important for a lot of reason, not the least in that it takes into consideration what CMS says are “many comments” and recommendations it’s received. The goal was to ensure plan sponsors put forth the right incentives to care for dual eligible populations over the long term. This change finalizes changes in payments that will affect plans differently depending on the characteristics of those plans.
It’s believed an expected revenue change of 1.25 percent is accurate and it does not account for expected growth in the coding acuity efforts. This adds another 2 percent. Medicare per capita spending in 2014, 2015 and 2016 is still expected to be below historical standards.
Also, Slavitt says that this announcement drives important improvements to the star rating system, additional accuracy and transparency of provider networks, and continues to promote improvements in quality of care for beneficiaries. The policies in the Rate Announcement and final Call Letter reflect Secretary Burwell’s commitment to a Medicare program – including Medicare Advantage – that delivers better care, spends health care dollars more wisely and results in healthier people. In the Final Call Letter, CMS continues to update the Star Ratings measures to drive improved quality for Medicare Advantage and Part D enrollees. To enhance program integrity and payment accuracy, Medicare Advantage plans will continue to be provided stringent oversight for improper payments, just like other providers in the Medicare program.
Lastly, the final policies will provide enrollees with greater information to make informed and timely decisions about their care and their coverage. The Final Call Letter takes steps to require Medicare Advantage plans to maintain accurate provider directories in a timely manner and make those directories more widely available. Again, this helps enrollees better understand the providers and choices available to them. In addition, CMS will ensure that Part D sponsors provide clear and accurate access to information on preferred cost sharing pharmacies in their networks so that all beneficiaries have access to affordable coverage.
If you have any questions regarding these changes or are interested in dual coverage and whether or not you qualify for it, contact our offices today.
Daniel DeBruyckere
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