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CMS Announces MA Rate Adjustment for 2020, Will Expand SDOH Health Benefits

Allison Inserro
CMS is expanding how Medicare Advantage (MA) can offer supplemental health benefits for the 2020 plan year, it said Thursday as it also announced the rate adjustment for the private plans that participate in the program.
CMS is expanding how Medicare Advantage (MA) can offer supplemental health benefits for the 2020 plan year, it said Thursday as it also announced the rate adjustment for the private plans that participate in the program. The agency is also continuing its effort to limit opioid prescriptions for Medicare beneficiaries.

MA payment rates for 2020 are expected to increase revenue by 1.59%. For the 2019 plan year, the change was 1.84%. The rate adjustment does not include an adjustment for the underlying coding trend that is expected to increase risk scores by 3.3%, CMS said. Risk scores are a measure of the sickness or health of the population served. Last year, risk scores were 3.1%.

The rate adjustment is “on a level that is commensurate with the original Medicare,” said Demetrios Kouzoukas, the principal deputy administrator for CMS.

In addition, CMS is encouraging plans to target health-related benefits to beneficiaries who suffer from chronic illness. This could include, for example, home-delivered meals, Kouzoukas said.

Last year, MA plans began offering benefits to address issues of social determinants of health (SDOH). In November 2018, HHS Secretary Alex Azar said the department would look to further align spending in traditional healthcare services with spending on services that relate to SDOH.  

The special supplemental benefits for the chronically ill will be available to beneficiaries who are chronically ill, meaning those who meet all 3 of these criteria:
  • Have 1 or more comorbid and medically complex chronic conditions that is life threatening or significantly limits the overall health or function of the enrollee
  • Have a high risk of hospitalization or other adverse health outcomes
  • Requires intensive care coordination
MA plans do not have to tell CMS how they identify those who qualify. CMS is accepting comments on these proposed changes until March 1. MA plans may contract with community-based organizations to provide these benefits.

However, if the supplemental benefit “does not have a reasonable likelihood of improving that specific enrollee’s health or overall function as related to the specific chronic illness” it may not be approved.

Kouzoukas said the changes are meant to encourage competition in MA plans, adding that MA and Part D premiums “are at their lowest level in 3 years.” The plans are nnot required to offer these supplemental benefits.

CMS is also proposing to continue an opioid policy that began last year and in addition, is encouraging plans to provide lower cost sharing for drugs like naloxone, which counteract an opioid overdose. It is also encouraging MA plans to offer benefits for pain panagement and complementary and integrative treatments for patients with chronic pain or undergoing treatment for substance use disorder, including lower cost sharing.

Last year, CMS expanded the use of its opioid overutilization monitoring system to identify high-risk beneficiaries and began requiring step-edits at the pharmacy level when an opioid is prescribed.

The agency said it will evaluate those efforts to see if there are unintended consequences while also continuing them. In addition, it will enhance opioid-related measures that go into a plan's Star ratings.

 
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