April 06, 2017
1 min read

CMS finalizes payment, policy updates for 2018 Medicare Health, Drug Plans

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CMS recently released final updates to the Medicare Advantage and Part D Prescription Drug Programs for 2018, according to a press release.

“Medicare is committed to strengthening Medicare Advantage and the Prescription Drug Program by supporting flexibility and efficiency,” Seema Verma, MPH, CMS administrator, said in the release. “These programs have been successful in allowing innovative approaches that give Medicare enrollees options that best fit their individual health needs.”

In 2018, CMS is changing the phase-in of the use of encounter data and will use encounter data for 15% of the risk adjustment payment to Medicare Advantage Plans.

Though similar to the Advance Notice and draft Call Letter proposed in February, the CMS final policies include several changes in response to feedback received during the public comment period. Medicare Health and Drug Plans can expect a revenue change of 0.45% on average and a total change of 2.95% in revenue when accounting for the expected growth in coding acuity. Plans that improve the quality of care they deliver will see higher updates and can enhance the benefits they offer to enrollees. The policies in the Rate Announcement offer incentives for plans to submit complete encounter data.

In addition, the policies will further fight overuse of opioids by urging safeguards before pharmacies dispense opioid prescription while maintaining access to needed medications for Medicare enrollees in the Part D prescription drug benefit. Part D sponsors are expected to improve the coordination of care among these enrollees using high dosage of opioids. CMS also expects the sponsors should consider expanding the care management they provide enrollees in the Medicare Advantage plans that include prescription drug coverage.

CMS is accepting comments on the Request for Information through April 24, 2017 to encourage feedback on ideas for regulatory, sub-regulatory, policy, practice and procedural changes in the Medicare Advantage and Part D.

Disclosure: Verma is a CMS administrator.