Modern Healthcare January 2, 2018
The CMS has proposed tweaking the way it pays Medicare Advantage health plans starting in 2019 by accounting for beneficiaries’ mental health, substance abuse disorder and chronic kidney disease conditions in the risk-adjustment model.
Under the proposed changes, risk scores would reflect the total number of conditions for an individual beneficiary, in addition to viewing conditions individually. By taking into account the number of conditions a beneficiary has among the conditions that are included in the Medicare Advantage payment model, the CMS said plans’ risk scores are projected to increase by 1.1%.
Plan members’ risk scores also would take into account certain diagnoses of mental health disorders, substance abuse disorders and chronic kidney disease.
For instance, the CMS proposed adding...
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