Lexology September 23, 2024
The Medicare Payment Advisory Commission’s (MedPAC) comparison of Medicare Advantage (MA) payments to traditional Medicare fee-for-service (FFS) spending shows parity when measuring MA payments from plan bids and quality bonus payments (described in Analysis 1 below). However, BRG’s analysis finds that MedPAC’s approach does not reflect expected reductions in payments to MA plans as a result of the transition to the new Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) risk adjustment model (v28) from 2024 to 2026. MedPAC applies the same risk- adjustment factor when calculating MA payments and FFS spending. As a result, risk-adjustment policies that change payment to MA plans have no effect on MedPAC’s ratio.
To show how v28 leads to relatively lower...
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