A Recipe for Medicare Advantage Chaos

By James Gutman - March 30, 2012

It is a timetable from hell in 2012 for Medicare Advantage plans. As usual, they will be submitting to CMS their bids for next year by the first Monday in June. The difference this time is that is likely to be before the ruling by the Supreme Court on the health reform law, and the decision could change everything for MA. While most of the focus during this week of Supreme Court hearings was on the individual mandate for commercial coverage and on the Medicaid expansion, MA also has a huge stake in this decision.

Let’s review what goes up in the air for MA if the high court throws out the entire reform law — a result for which chances seemingly moved from remote to not remote after hearing the justices’ questions and comments during oral arguments this week. First, that means the CMS star-rating bonus payment program may be over since it was created by the reform law.

Second, the payment phasedown to 100% of fee-for-service rates would be out, since that also was established in the law. What would replace it? Plans can guess, but they probably won’t actually know anything by when their bids are due June 4.

In addition, there are all those tremendous opportunities in the new programs for Medicare-Medicaid dual eligibles. These demonstration programs are to be run by the CMS duals office and funded by the agency’s Center for Medicare and Medicaid Innovation, both of them created in the reform law. If the statute is gone, so are those entities, and it is doubtful that many states could fund these demos on their own. And then there’s the new accelerated Oct. 15-Dec. 7 Annual Election Period for MA and Part D. That was created by the reform law. If the statute is gone, does this mean we go back to the old Nov. 15-Dec. 31 dates and to the plan-to-plan switch period at the beginning of the next year?

How do you plan for these kinds of quantum changes? Is it safe to assume that CMS could find other ways to keep the new programs and schedules going? Is the roller-coaster ride just beginning?