Proposed Medicare Advantage changes would help account for substance abuse, mental health

CMS issued proposed changes to the way Medicare Advantage beneficiary risk is scored in 2019, which would incorporate mental health, substance abuse disorder and chronic kidney disease into the risk-adjustment model.

The proposal also includes changing the risk-adjustment model to take the number of conditions a beneficiary has into account, as well as making a handful of technical updates.

The MA risk score is based on the beneficiary's expected medical cost compared to that of a beneficiary enrolled in traditional Medicare. It is used to help ensure MA payments are appropriate for the level of risk of the beneficiaries in the program.

If approved, the changes would be phased in over three years, becoming fully implemented in 2022. The proposal is open for comment until March 2.


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