Becker's Healthcare March 27, 2023
Nonprofit payer executives are urging CMS to pause its proposed changes to Medicare Advantage to ensure coding updates will not harm dual-eligible MA members.
At a panel discussion hosted by the Special Needs Plans Alliance on March 27, leaders from health plans and the American Physicians Group said the proposed coding changes will have a disproportionate impact on beneficiaries in dual-eligible and other special needs plans.
Dual-eligible beneficiaries are eligible for both Medicare and Medicaid benefits on the basis of income or other factors. Around 44 percent of dual-eligible beneficiaries are in fair or poor health, compared with 17 percent of Medicare beneficiaries without Medicaid. They are also more likely to have conditions associated with higher spending.
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