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 CMS Releases Second Part of 2019 MA Program Notice and Call Letter

More proposed changes for the Medicare Advantage (MA) program were revealed on Feb. 1 when the Centers for Medicare & Medicaid Services (CMS) released Part II of the calendar year (CY) 2019 Advance Notice and Draft Call Letter for MA and Medicare Part D. MA affects not only skilled nursing facility (SNF) reimbursement but is also an area more long term and post-acute care providers are either entering as health insurers outright or in partnership with other entities.

While Part I of the MA and Part D notice released late last year focused on the MA risk adjustment model, Part II includes updated payment rate information and other proposed technical changes for plan sponsors ahead of the bidding process for the upcoming plan year. 

In reviewing Part II, sources at the American Health Care Association/National Center for Assisted Living said many of the proposed policy changes are in line with those CMS included in a November 2017 proposed rule. For instance, the proposed policies seek to promote MA plan flexibility and cut administrative red tape for MA and Part D plans. 

The industry sources said highlights of the Part II notice and letter for SNFs include:

--CMS expects CY 2019 MA plan payments to rise 1.84 percent, on average, which is up from the 0.45 percent plans received last year. When account plan coding of member diagnoses is factored in, the average payment will increase by 3.1 percent, up from a 2.95 percent increase last year.

--CMS wants to adopt a “Readmissions from Post-Acute Care” measure for plan year 2020 to evaluate acute facility readmissions among Medicare beneficiaries during or after a stay in a SNF. CMS has said a readmission event during or after a SNF stay may be the result of inadequate provider communication during care transitions and/or poor discharge practices. The proposed change would likely raise the pressure on MA plans to oversee, evaluate, and assess performance of contracted SNFs. 

--The draft Call Letter reminds plan sponsors that CMS believes plans can offer reduced cost sharing and/or expand supplemental benefits for specific enrollee populations based on health status or disease. This is if sponsors ensure that similarly situated individuals are treated the same. CMS is also redefining health-related supplemental benefits to include additional services, including coverage of non-skilled in-home supports. CMS sees this flexibility helping MA plans to better manage health care services for particularly vulnerable beneficiaries.   

For its part, CMS said the proposed changes are aimed at giving more options and new benefits to beneficiaries. The agency also highlighted steps to “ensure new patient-doctor-plan communication in combatting the opioid crisis.”

MA remains popular among beneficiaries and has high satisfaction ratings. “In 2018, MA and Part D premiums decreased and the number of MA plans available to choose from across the country increased from about 2,700 to more than 3,100—and enrollment in MA is at an all-time high as approximately one-third of all Medicare beneficiaries are enrolled in a plan,” CMS said.

A fact sheet is available at: CMS has set a March 5 deadline for comments on the proposals in Part I and Part II.

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