Topic: Brain Food

The New Medicare Advantage Supplemental Benefits Policy Is the Biggest News in Years

David Sayen

The draft 2019 Call Letter for Medicare Advantage (MA) included new flexibility for plans around supplemental benefits. It was codified in the recent budget resolution to keep the government open and represents the biggest news for the industry in years. It offers a whole new toolbox for plans to address social determinants of health.

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Advance Notice Update – Risk Adjustment

Jessica Smith

Now that Part II of the Advanced Notice and Call Letter has been released, we are able to get a full view of the proposed policy changes to pave the way for the future. For risk adjustment, the release of Part II did not contain any surprise policy changes. The crux of risk adjustment changes were included in the Part I release. Preliminary industry impacts of the Part I release are outlined in one of my prior blogs at the following link: https://www.gormanhealthgroup.com/blog/the-ever-growing-complexity-of-risk-score-calculation-proposed-changes-for-2019-payment-year/.

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House Passes Spending Bill That Includes Many Medicare Advantage Policies; Senate Announces Two-Year Budget Deal

Olga Walther

On Tuesday, the House passed a bill that would fund the government through March 23, 2018. Meanwhile, the Senate leaders announced Wednesday afternoon they have reached an agreement on a two-year spending deal. The Senate budget deal includes another four years of Children’s Health Insurance Program (CHIP) funding, added to the previously authorized six-year extension. The bill also contains two years of funding for community health centers, and adds $6 billion for the opioid epidemic. The deal will also terminate the Independent Payment Advisory Board. Though it is still uncertain whether the Senate deal has enough support to make it through the House, with both Democrats and budget hawks on the fence, it is reported that the Senate is planning to attach this budget deal to the previously passed House spending bill, and send it back to the House for a vote.

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Data Universes – Friend not Foe

Tina Bailey

Data universes are not new in the Medicare Advantage and Part D space. The Centers for Medicare & Medicaid Services (CMS) requires data universes for a variety of purposes, including program audits and timeliness monitoring. Gorman Health Group has communicated time and time again the importance of pulling accurate universes as well as continuous review of that data. Universes tell a story often not heard via other monitoring efforts.

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CMS Reports Medicare Advantage Provider Directories Continue to be Plagued with Inaccuracies

Elena Martin

The Centers for Medicare & Medicaid Services (CMS) issued its Round Two online provider directory review, and the results were dismal. Plans reviewed showed an overall inaccuracy average higher than Year One plans. We can try to marginalize the results and say the average inaccuracy found by location was 48%. Nevertheless, the fact remains that nearly half of all directory locations reviewed were inaccurate. Breaking it down further, the inaccuracies ranged from 11% to 97.82%. We are living in an age of tech-savvy consumerism. If our GPS or Google results proved incorrect half of the time, we would not be satisfied. If results proved correct less than 3% of the time, we would be outraged.

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Advance Notice Update: Star Ratings

Melissa Smith

With the much anticipated Advance Notice now in hand, we have our first glimpse into the Centers for Medicare & Medicaid Services (CMS) proposed changes to the 2019 and 2020 Star Ratings. Though CMS hasn’t yet proposed any noteworthy changes (or removed any measures) as part of its “Meaningful Measures” or “Patients Over Paperwork” initiatives, there are plenty of proposals to be carefully considered. Here’s a quick summary of CMS’ proposals impacting the 2019 Star Ratings: Read more

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CMS Releases Part II of the Medicare Advantage Advance Notice & Draft Call Letter

Olga Walther

On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Advance Rate Notice (Part II) and Draft Call Letter. CMS estimates an expected increase of 1.84% to payments in 2019. CMS says its estimates do not reflect underlying coding trend, which it expects to increase risk scores by 3.1% in 2019.

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