More than 60 U.S. Senate members have sent a letter to the Medicare and Medicaid Service Centers urging the agency to protect Medicare Advantage while keeping rates stable, as CMS is expected to end its MA rate announcement for 2023 on April 4th.
Senators praised the virtues of Medicare Advantage, citing its varied benefits (meal services, telehealth, home care, nutrition services, hearing, dentistry, and the like) and said the program has been instrumental in helping enrolled in staying healthy and safe during the period. Covid pandemic19.
This, the senators said, is the main reason why they urge the Biden Administration to maintain stability in the MA program, as they called for progress in the plan’s flexible benefit offerings and to promote coordination of care. .
“We are committed to ensuring that our voters who depend on Medicare Advantage enjoy the same access to affordable benefits to get the care they need, especially as they navigate the persistent pandemic challenges,” the letter says.
WHAT IS THE IMPACT
Senators said they appreciated the administration’s “continued commitment to preserving and strengthening the program, as demonstrated in the CMS 2023 Medicare Advantage proposal and the Part D advance notice.”
CMS released this notice earlier this month, with the stated intention of creating more options and offering affordable options for consumers.
The agency’s ultimate goal for Medicare Advantage is to match CMS’s vision for its programs as a whole, which Administrator Chiquita Brooks-LaSure said is “advancing health equity; person-centered and promote the affordability and sustainability of health. ” Medicare program. ”
CMS proposes an effective growth rate of 4.75% and an average overall change in revenue of 7.98%, following a 4.08% increase in revenue forecast for 2022.
The proposed rule provoked a backlash from several organizations, including the Better Medicare Alliance.
“As we continue to review the advance notice in more detail, we’re grateful that CMS has come up with a thoughtful proposal that will help ensure stability for the millions of older people with multiple disabilities who have Medicare Advantage,” said Mary Beth. Donahue, president and CEO of the Better Medicare Alliance, said, adding that the proposal promotes the shared goal of improving health equity.
“Medicare Advantage has proven its worth to seniors and taxpayers by providing lower costs, significant benefits that address the social determinants of health, better outcomes, and greater efficiencies for the Medicare dollar,” he said. “A stable rate for 2023 ensures that this work can continue. On behalf of our 170 allied organizations and more than 600,000 advocates for beneficiaries, we applaud CMS for putting seniors first by issuing advance notice which protects coverage options, advances healthcare equity and preserves affordability for beneficiaries. ”
AHIP also responded, and President and CEO Matt Eyles noted that by 2022 the average monthly Medicare Advantage premium had dropped to $ 19, up more than 10% from 2021.
“Medicare Advantage has strong bipartisan support because it provides seniors in the United States and people with disabilities with access to affordable, high-quality health care,” Eyles said.
CONCERNS
While groups urge to keep Medicare Advantage stable, the Medicare Payments Advisory Committee has said that expanding the program to a growing percentage of Medicare beneficiaries may be a cause for concern.
Enrollment has grown to 10% annually, MedPAC said in a written testimony released earlier this month. Last year, an estimated 46% of eligible Medicare beneficiaries were enrolled in plans. If the trend continues, most seniors will be enrolled in MA plans, rather than original Medicare.
MA is costing the government more than the traditional program. Private risk-taking private plans, which have been available on Medicare since the mid-1980s, have never generated aggregate savings for the program, MedPAC said. The group estimates that 2022 Medicare payments in MA plans are about 104% of what Medicare would have spent on those same beneficiaries in a traditional service rate model.
That’s why, in MedPAC’s view, the shift to MA may worsen Medicare’s sustainability and make the need for structural improvements to the program more urgent.
MedPAC put forward a number of suggestions to improve this situation. One is to develop a risk adjustment model that uses two years of diagnostic data instead of one, which would make pay-per-service diagnostic data more complete and reduce the marginal benefit for MA plans to code. additional diagnoses; According to MedPAC, more intense coding in MA relative to FFS results in higher payments to the plans and increases program spending.
In 2020, coding differences increased payments to plans by about $ 12 billion, the figures showed, undermining plans’ incentives to improve quality or reduce costs, MedPAC said.
MedPAC also had issues with the MA Quality Bonus Program, which provides higher payments to plans with a rating of four stars or more on a five-star scale. According to the organization, QBP uses too many quality measures focused on the process rather than on patient outcomes and experience. In addition, these star ratings are determined at the MA contract level, which often cover larger geographic areas and may not be a reliable indicator of the quality of care in a more local area, a problem that is exacerbated because plan sponsors consolidate contracts to artificially improve their star ratings. , an issue that has been partially addressed at the legislative level.
The group recommended that the QBP be replaced by a value incentive program that, among other things, would assess quality at the local market level and fund the MA quality system in a budget-neutral manner to be more consistent with the quality of the Medicare service charge. payment programs, which are budget neutral or result in program savings because they involve penalties.
THE GREATEST TREND
The U.S. Senate is now the second chamber in Congress to urge the CMS to maintain the stability of the MA tariff. In late January, the House of Representatives drafted its own letter to CMS, urging the agency to “provide a stable rate and policy environment that will ensure that Medicare Advantage can continue to provide affordable, high-quality coverage. and patient – centered confidence that our constituents trust every day. ”
They continued to express a desire to work with CMS “to ensure that, through Medicare Advantage, tens of millions of older adults continue to have access to comprehensive and affordable health coverage options.”
The letter from Congress followed the Morning Consult poll which shows that 92% of Medicare Advantage beneficiaries consider the support of a candidate for the program to be important in winning their vote.
Urging CMS to maintain the stability of the Medicare Advantage program, Kaiser Family Foundation statistics show that enrollment in MA has almost doubled in the last decade, with more than 43% of beneficiaries of Medicare who chose to enroll.
The signatories also highlighted CMS’s own data showing that 90% of those enrolled in MA are in a plan with a quality rating of four or more stars. They maintained MA “offers consistently better care and value that provides beneficiaries with more coordinated access to high-quality providers and less avoidable visits to the hospital and emergency department.”
Several major insurers, such as UnitedHealthcare, Swan and Centene, have significantly expanded their MA footprints in recent months, seeing a potential market opportunity in the program’s still-growing popularity.
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