Healthcare DIVE January 2, 2018
Dive Brief:
- Payers in Medicare Advantage (MA) may soon see a change to its risk adjustment model that will take into account mental health, substance use disorder and chronic kidney disease and makes adjustments “to take into account the number of conditions an individual beneficiary may have.”
- In the CMS’ “2019 Medicare Advantage Part I Advance Notice – Risk Adjustment,” the agency offered changes to MA capitation rates and Part D payment policies. The CMS proposed a Payment Condition Count model, which is expected to increase MA risk scores by 1.1%.
- While increasing risk scores through the Payment Condition Count, the CMS would also decrease MA risk scores by 0.28% in the alternative All Condition Count model.
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