Medicare Advantage Plans receive a proposed 1.03% payment increase in 2024.

Photo: Kittifan Tiravattatanakul/Eye Em/Getty Images

Medicare Advantage Plans is expected to receive a 1.03% revenue increase in accordance with the 2024 Medicare Advantage and Part D Prescription Advance Notice released by the Centers for Medicare and Medicaid Services on Wednesday.

CMS proposes technical updates to the MA risk adjustment model through a full transition to the Internal Classification of Diseases from ICD-9 to ICD-10. The latter has been in use since 2015. It also updates baseline service fee data for years from 2014 diagnoses and 2015 expenditures to 2018 diagnoses and 2019 expenditures.

According to prior notice, the revision and normalization of the risk model is -3.12%.

According to Dr. Mina Seshamani, Associate Administrator and Director of the Center for Medicare, the revised risk adjustment in the pre-notice is linked to the final CMS Risk Adjustment Data Validation (RADV) rule released on Monday.

The RADV rule addresses issues where there are no diagnoses to support the codes, Seshamani said during a press conference on Wednesday. According to the CMS, Advance Notice includes fixes to reduce model sensitivity to encoding variations.

The advance notice growth rate is 2.09% and is largely driven by per capita Medicare fees. According to CMS, it includes a proposed technical amendment related to indirect and direct medical education costs associated with services provided to MA applicants.

The MA star rating change is -1.24% and the MA risk score trend is 3.3%.

Taken together, the expected average change in revenue is 1.03%.

WHY IS IT IMPORTANT

The Advance Notice provides updates on MA payment growth rates and changes to MA and Part D payment methods.

Comments must be submitted by March 3rd.

The Medicare Advantage and Part D payment policy for 2024 will be finalized in the 2024 Rate Announcement, which will be posted no later than April 3rd.

In addition, CMS is seeking input on measuring MA quality against Part C star ratings as part of CMS’ efforts to align quality measures across federal programs and with private payers.

The advance notice builds on a proposed rule published by CMS in December 2022 that, if finalized, would enhance beneficiary protections in Medicare Advantage and Medicare Part D prescription drug coverage, CMS said in a statement.

In addition to the payment updates, the Advance Notice describes several updates and improvements made by the Inflation Reduction Act to the Part D program that will take effect or be effective January 1, 2024.

These include continuing to reduce insulin cost-sharing and eliminating cost-sharing for recommended preventive vaccines, as well as removing Part D prescription drug shares in the catastrophic phase and expanding eligibility for full cost-sharing and premium subsidies under the subsidy program for the poor. .

With these 2024 Part D changes, the new drug law provides financial assistance to millions of people on Medicare by improving access to affordable treatments and strengthening the Medicare program now and in the long term, CMS says.

BIG TREND

Earlier this week, CMS completed a risk adjustment policy in the final rule to prevent overpayments to Medicare Advantage organizations.

Studies and audits conducted separately by CMS and the Office of the Inspector General of Health and Human Services have shown that the medical records of Medicare Advantage members do not always support the diagnoses reported by the MAO, resulting in billions of dollars of overpayments on plans and increased treatment costs. the Medicare program, as well as taxpayers, the CMS final rule says.

AHIP President and CEO Matt Ailes called the rule “illegal” and “fatally flawed” and said it should have been repealed, not tweaked.

IN RECORDING

“The sound-sense advance notice proposals, combined with the proposals in the MA and Part D rules released in December, ensure that these important programs continue to meet the medical needs of all beneficiaries, improving the quality and long-term stability of the Medicare program. said CMS Deputy Administrator and Medicare Center Director Dr. Mina Seshamani.

Twitter: @SusanJMorse
Write to the author: [email protected]