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CMS gives bigger increase to Medicare Advantage payment rates for 2018

But America's Health Insurance Plans says it does not fully support the just-announced payment rate because it falls a little short.

Susan Morse, Managing Editor

Medicare Advantage health plans can expect to see average payment increases of .45 percent in 2018 compared to the .25 percent proposed by the Centers for Medicare and Medicaid Services in its  advanced rate notice on Feb. 1.

The expected average change in revenue, when taking into account coding trends, will be 2.95 percent rather than the 2.75 percent in  February's notice.

The update is due to changes in coding acuity,  senior Medicare officials said Monday.  It takes into account increases in risk adjustment payments due to demographics, as well as more chronic conditions being reported in diagnosis codes to CMS.

Last year, CMS implemented a .25 percent payment increase for 2017 that was supposed to double to .50 percent in 2018.

[Also: Court combines two whistleblower suits against UnitedHealth alleging Medicare Advantage fraud]

When another .25 percent increase was announced in February, close to 350 members of Congress voiced their concern about the cut, according to America's Health Insurance Plans.

"While CMS made adjustments to some policies, and we welcome the request for information, we believe more must be done to ensure beneficiaries are well supported in achieving their best health," said AHIP CEO and President Marilyn Tavenner after Monday's announcement. "We look forward to working with the agency to reduce unnecessary regulatory burdens, enhance program flexibility and innovation, and promote delivery system reform and patient engagement."

For the first time, CMS is releasing a request for information for Medicare Advantage and Medicare Part D, with comments due by April 24. Stakeholders are encouraged to comment on such options as benefit design or operational flexibility.

"With the new administration, there is an interest in collecting ideas from the public about how we can foster additional innovation," senior officials said. "It's a broad request."

CMS calculates risk scores using diagnoses submitted by Medicare fee-for-service providers and by Medicare Advantage organizations.

The risk scores are based on data from the risk adjustment processing system, or RAPS, and in recent years has included encounter data submitted by MA organizations.

[Also: Healthcare costs will outpace Medicare Advantage payments in 2018, report says]

"We've gotten numerous concerns from plans in using encounter data," officials said.

In 2017, CMS used a blend of 75 percent RAPS, and 25 percent encounter data and proposed in February using the same figures.

However, after listening to concerns, in 2018, the blend will be 85 percent to 15 percent, CMS said.

CMS is also finalizing policies that will further combat opioid overuse by encouraging safeguards before an opioid prescription is dispensed at the pharmacy. The agency will impose what is called a hard edit in getting a prescription filled.

"CMS believes that Medicare Advantage organizations and Part D sponsors, working with prescribing physicians, are in the best position to identify and employ best practices and the most appropriate care management interventions for enrollees using high -dosage opioids," CMS said.

Twitter: @SusanJMorse