by RISE
23. February 2011 01:58
Last Friday CMS posted the Advance Notice of Methodological Changes for Calendar Year (CY) 2012 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2012 Call Letter. The officials held the press conference to announce the posting of the 153-page:
http://www.cms.gov/MedicareAdvtgSpecRateStats/Downloads/Advance2012.pdf
Premature Synopsis:
If there is one thing we know, it is that the devil is always in the details!
The final Rate Notice for 2012 will be announced on April 4th 2011, however this draft letter has consistently proved to be an accurate indicator of the debate ongoing in D.C. In the meantime the thought leaders in our industry have until March 4th to comment on the Notice and Call Letter.
Information about agent and broker compensation structures is not due until July 25, 2011.
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The national per capita Medicare Advantage health plan "growth percentage" change, or cost trend, will be just 0.7%, but quality rating bonus should increase the average actual Medicare Advantage per-capita payment 1.6%.
- In 2012, plans that have 4-star or 5-star quality ratings on a 5-star scale will get higher payments than other plans, and plans in some counties will get higher payments than in other counties.
- CMS will offer a special enrollment period in 2012 to help a Medicare Advantage enrollee switch to a plan with a 5-star rating at any time during the year.
- CMS is not planning to change coding intensity or risk adjustment factors.
- CMS will put bids that call for total premium and out-of-pocket cost increases of 10% or more through a more intensive level of review, according to officials.
- CMS is including the rate review threshold in the bidding process because of complaints that it applied a threshold during the 2011 bidding process without warning the bidders, according to officials.
- In the draft call letter, CMS officials note that they may eliminate some ordinary Medicare Advantage plans that have been in existence for 3 or more years but have fewer than 500 enrollees.
- CMS may also eliminate some "special needs plans" with fewer than 100 enrollees.
- To keep a low-enrollment plan going, a Medicare Advantage organization "must provide justification for low enrollment under the standards in the final rule or confirm through return email that the plan will be eliminated or consolidated with another of the organization‘s plans for [Calendar Year] 2012.
- CMS will consider renewing a low-enrollment plan if reasonable factors, such as geographic location, are responsible for the low enrollment level, officials say.
Kenneth Persaud, CEO, PRECISION HEALTHCARE SYSTEMS
