CMS is seeking input on an Advanced Notice that includes proposed changes to Medicare Advantage capitation rates and Part D payment policies.
The notice was issued Feb. 2, opening a window for public comment through March 3. CMS will publish finalized policies on April 4.
Nine details:
1. CMS is increasing Medicare Advantage revenue by nearly 8 percent in 2023, anchored by increases to its effective growth rate, which is up 4.75 percent. Also increasing is Medicare Advantage's risk score trend, up 3.5 percent year over year.
2. The agency will continue to use the 2022 CMS-HCC model to calculate 100 percent of the risk score for Part C. Risk score calculations will continue to be fueled by MA encounter data submissions and fee-for-service claims.
3. The Advanced Notice pitches a change to end stage renal disease risk adjustment that uses more recent data. The approach will apply to ESRD programs outside of the Program of All-Inclusive Care for the Elderly, which will continue to use the 2017 CMS-HCC model.
4. CMS is implementing a statute-minimum 5.9 percent coding pattern adjustment to diagnosis coding between Medicare Advantage organizations and fee-for-service providers.
5. On the Part D front, CMS proposes updating its RxHCC risk adjustment model, which would include ICD-10-CM diagnosis codes rather than ICD-9-CM codes and updated data.
6. CMS is also soliciting feedback on Part C and Part D plan star rating adjustments.
7. According to the Advanced Notice, the agency is aiming to use Medicare Advantage and Part D changes to advance health equity. Much of this involves collecting additional data on beneficiaries' race, ethnicity and social determinants of health, developing equity-focused quality measures, and driving funding toward programs that advance equity.
8. America's Health Insurance Plans issued a Feb. 2 statement supporting many of the changes, including decreasing premiums and increasing health equity.
9. "We agree that MA plans play an essential role in improving health equity and addressing the social determinants of health that impact millions of seniors and people with disabilities," said Matt Eyles, AHIP CEO and president. "We support CMS soliciting input on ways to advance these important goals."