Tag: Affordable Care Act

Medicare Advantage Rate Adjustments

According to a recent proposal posted by CMS this week, health insurers offering Medicare Advantage plans will see their rates cut by approximately .95 percent in 2016.  The finalized payment rates are expected to be final April 6th.  Below is a copy of the proposed changes by CMS.




NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties

SUBJECT: Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter

In accordance with section 1853(b)(2) of the Social Security Act, we are notifying you of planned changes in the MA capitation rate methodology and risk adjustment methodology applied under Part C of the Act for CY 2016. Also included with this notice are proposed changes in the payment methodology for CY 2016 for Part D benefits and annual adjustments for CY 2016 to the Medicare Part D benefit parameters for the defined standard benefit. For 2016, CMS will announce the MA capitation rates and final payment policies on Monday, April 6, 2015, in accordance with the timetable established in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

Attachment I shows the preliminary estimates of the national per capita MA growth percentage and the national Medicare fee-for-service growth percentage, which are key factors in determining the MA capitation rates. Attachment II sets forth changes in the Part C payment methodology for CY 2016. Attachment III sets forth the changes in payment methodology for CY 2016 for Part D benefits. Attachment IV presents the annual adjustments for CY 2016 to the Medicare Part D benefit parameters for the defined standard benefit. Attachment V presents the preliminary risk adjustment factors.

Attachment VI provides the draft CY 2016 Call Letter for MA organizations; section 1876 cost-based contractors; prescription drug plan (PDP) sponsors; demonstrations; Programs of All-Inclusive Care for the Elderly (PACE) organizations; and employer and union-sponsored group plans, including both employer/union-only group health plans (EGWPs) and direct contract plans. The Call Letter contains information these plan sponsor organizations will find useful as they prepare their bids for the new contract year.