February 03, 2017
2 min read

2018 proposed Medicare policy updates include small rate hike

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In an Advance Notice and Draft Call Letter, CMS recently proposed updates for the Medicare Advantage and Part D Prescription Drug Programs in 2018. If the changes are finalized they will offer stable and fair payments to plans, according to a press release.

“Medicare Advantage is an essential, growing part of the Medicare program,” Patrick Conway, acting administrator of CMS, said in the release. “These proposals will continue to keep Medicare Advantage strong and stable and provide high quality, affordable care to seniors and people living with disabilities.”

Medicare Advantage plans will have a small net payment increase of 0.25% on average, resembling last year’s growth and a similar pattern in Medicare fee-for-service.

In its proposal, CMS is requesting to continue its use of the 2017 blend for payment system that incorporates a higher percentage of encounter data-based risk scores. CMS is seeking comments on whether and how to implement a consistent industry-wide adjustment to these scores in 2018.

For 2018, CMS is proposing a coding pattern adjustment that emulates the statutory minimum. In addition, CMS is looking to keep its administrative setting rate policy for Medicare employer retiree plans in 2018, but is seeking comments on whether it should continue its 2017 bid-to-benchmark ratios or use only individual market plan bids. 

CMS is also proposing to add cost sharing thresholds for cardiac rehabilitation services, intensive cardiac rehabilitation services and pulmonary rehabilitation services to safeguard discriminatory and high cost sharing. To incentivize beneficiaries to use primary and specialty care services for routine, non-emergent care, the CMS is also looking to increase the Emergency Care/Post Stabilization Care limit for plans for 2018.

To address concerns within Medicare Part D regarding drug utilization, the CMS is seeking to revise the retrospective drug utilization review criteria to align better with the opioid prescribing guideline by the CDC and to establish the expectation of sponsors to implement opioid overuse prevention efforts at the time of sale at the pharmacy.

The Medicare Advantage program will be strengthened and improved by the proposed policies for current and future generations, according to the CMS.

The CMS is inviting comments on the proposed Advance Notice and Draft Call Letter until March 3, 2017. It will publish its final 2018 Rate Announcement and Call Letter by Monday, April 3, 2017.

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Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures.