Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and
business strategies about Medicare Advantage plans, product design, marketing,
enrollment, market expansions, CMS audits, and countless federal initiatives in
MA and Medicaid managed care.
August 28, 2014
Volume 20 Issue 16
A group of speakers voiced strong
support for the Medicare Advantage program at a July 24 House Ways and Means
Health Subcommittee hearing that seemed more designed to let organizations air
recommendations for protecting the program than to work for any specific
legislation this year. Indeed, the panel’s chairman, Rep. Kevin Brady
(R-Texas), who put together the hearing, asserted in his announcement of it
that MA products “are being threatened by cuts in the Affordable Care Act and
onerous regulations,” but did not mention any bill to deal with this.
Of the witnesses at the hearing, only
one (Medicare Rights Center President Joe Baker) defended the health reform
law’s impact on MA and suggested that “the ACA enhanced MA on several fronts,
including through added benefits, fairer cost sharing, and improved plan
quality.” The other witnesses, along with a statement submitted for the hearing
by the America’s Health Insurance Plans trade group, depicted an MA industry
under siege because of government policies.
“CMS must keep payment rates to MA
plans stable,” said, for instance, Chris Wing, CEO of SCAN Health Plan, a large
not-for-profit operator of MA Special Needs Plans (SNPs) in California and
Arizona, in his prepared testimony for the hearing. Wing noted the cuts to MA
plan payment rates included in the ACA and other laws enacted after it, saying
“seniors have begun to feel the impact of these cuts in higher out-of-pocket
costs, reduced benefits, and winnowing choice.”
In response to a question after his
testimony, Wing said that SCAN will have to withdraw MA plans from some
communities in 2015 because of the ongoing payment reductions. He did not
elaborate on the service areas and products involved, and Peter Begans, the
company’s senior vice president, public and government affairs, tells MAN
that SCAN can’t furnish those details until after CMS completes action on its
pending bids. An MAN source, though, says SCAN is dropping chronic care
SNPs in Arizona.
In his testimony, Wing criticized some
aspects of how CMS treats its star quality ratings, saying that “because CMS
makes changes to the criteria, as well as to the weighting of the criteria,
each year, plans may make certain investments to comply with measures that cease
to exist before those investments are realized.” Aside from urging CMS to “hold
the criteria as stable as possible,” Wing said the agency should “look at
whether the current risk adjustment models should be updated to better predict
the cost of high-risk patients.”
Another witness, Jeffrey Burnich, M.D.,
a senior vice president of Sutter Health who testified on behalf of the
California Association of Physician Groups, said, “To truly encourage and
incentivize the development of additional two-sided risk models in Medicare
Part B, the MA program should be not just protected, but strengthened.” He
added that “I am concerned that the cuts to the MA program will push both
physicians and patients out of the program and back into fragmented FFS [i.e.,
fee-for-service] models.”
A third witness, Robert Book, Ph.D.,
senior research director at Health Systems Innovation Network, LLC and an
advisor to the right-leaning American Action Forum, said a new AAF study based
on published county payment rates and CMS enrollment data shows the average MA
enrollee will face a reduction in benefits of about $317 or 3% in 2015 compared
with 2014. The total reduction for 2015 compared with the pre-ACA baseline, he
added, is more than $1,530 per beneficiary or 13%, and AAF forecasts the
average benefit cut for 2017 compared with that baseline is more than $3,700 or
nearly 27%.
Medicare Rights Center’s Baker,
however, defended the payment cuts in the ACA, asserting in his testimony that
before the reform law “MA overpayments historically drove up premiums for all
Medicare beneficiaries, including those who remained in original Medicare.”
Moreover, according to Baker, “there is no evidence that changes to MA
reimbursement have or will disproportionately harm low-income Medicare beneficiaries,
most notably those dually eligible for Medicare and Medicaid, and diverse
communities.”
He urged Congress to make such changes
in MA as barring plans “from asserting or implying that standard benefits, like
an out-of-pocket cap or free preventive services, are unique to a given MA
plan.” And Congress, Baker testified, should “consider standardizing MA benefit
packages” as a way “to encourage ‘apples-to-apples’ comparisons.”
“For some older adults and people with
disabilities, MA plans are a good option, but for many others original Medicare
is a better choice,” he contended.
View the subcommittee hearing testimony
at http://waysandmeans.house.gov/calendar/eventsingle.aspx?EventID=388348.
http://aishealth.com/archive/nman082814-04?utm_source=Real%20Magnet&utm_medium=Email&utm_campaign=51093398
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