Fierce Healthcare January 2, 2018
CMS is proposing changes to how it calculates Medicare Advantage risk scores.
Over the holidays, Medicare Advantage insurers got a gift from the federal government.
That gift arrived on Dec. 27, when the Centers for Medicare & Medicaid Services released part one (PDF) of its 2019 advance notice of changes to MA capitation rates and Part D payment policies. The advance notice is split into two parts this year because of requirements related to the 21stCentury Cures Act, per a CMS fact sheet.
To comply with the Cures Act, CMS is proposing an MA risk adjustment model that includes additional mental health, substance use disorder and chronic kidney disease conditions. The agency uses risk adjustment models to adjust payments based...