CMS Proposed Changes for Medicare Advantage and Part D Prescription Drug Programs

Recently, the Centers for Medicare and Medicaid Services (CMS) released proposed changes for the Medicare Advantage (MA) and Part D Prescription Drug Programs. These changes is believed to advance HHS secretary Sylvia M. Burwell’s vision of building a better and smarter health care system, and moving the Medicare program and the health care system toward paying providers based on the quality, and not the quantity of care they give to patients.

“The proposed rates will enhance the stability of Medicare Advantage program and minimize disruption to seniors and care providers,” said Andy Slavitt, CMS Principal Deputy Administrator. “The policies in the Notice and Call Letter will continue the movement to reward providers of high quality, consumer-friendly care for the Medicare Advantage and Part D programs.”

Since the passage of the Affordable Care Act, the MA and the Part D Prescription Drug programs’ enrollments and quality are persistently growing. MA has reached record high enrollment each year since 2010, a trend progressing in 2015 with a total increase of more than 40 percent since Affordable Care Act, and more than 90 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.

The popularity of this program is a clear sign that Medicare Advantage and the Prescription Drug Program are attractive to health plans and beneficiaries alike. This new proposal will continue this trend by providing fair payments to plans, rewarding high-quality care, and spending our health care dollars wisely. The CMS believes this new proposed policies will minimize disruption and continue our commitment to high-quality plans, and create a stable and consistent policy environment.

CMS also estimates that 60 percent of Medicare Advantage enrollees will be in 4 or 5 star plans in 2015. In the Draft Call Letter, CMS is proposing to continue to refine the star rating system in order to encourage improved quality, as well as a proposal to modify the system to make sure plans are not unfairly penalized for enrolling dual eligible or low-income beneficiaries. Plus, the proposal enhances the value of in-home assessments so they are used to support care planning and care coordination and improve enrollee health outcomes.

Finally, the proposed policies provide enrollees with greater information to make informed decisions about their care and their coverage. You can view The Advance Notice and draft Call Letter here:

Source: CMS

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