By James
Gutman - March 18, 2015
It seems to happen every year, and 2015
looks like no exception. From the time CMS releases in late February its draft
Medicare Advantage plan payment notice and MA and Part D Call Letter for the
following year, and until the final document comes out the first Monday in
April, there’s a battle of press releases and lobbyists seeking to change or
retain provisions in the draft document. And some of the back-and-forth
rhetoric can get quite heated — and interesting.
Consider what already has occurred
since CMS released the 2016 draft notice and Call Letter Feb. 20. On Feb. 25,
the America’s Health Insurance Plans (AHIP) trade group came out with an
actuarial study from Oliver Wyman finding the net 2016 pay cut for MA proposed
in the initial notice would reduce MA payments by more than CMS had predicted
(1.2% versus 0.9%). Just for good measure, AHIP on March 17 supplemented this
with a state-by-state analysis by Wyman showing how big the impact would be in
dollar terms. “Seniors cannot afford another cut to their Medicare Advantage
coverage,” said AHIP President and CEO Karen Ignagni in a prepared statement
accompanying the March 17 study.
Republican party officials saw an
opportunity to capitalize on the controversy surrounding the rate-cut proposal
and came out with their own tailored version of the impact of proposed MA cuts.
Not surprising they blamed it all on the Affordable Care Act and the Democrats
who passed the statute. “Now that those cuts are starting to negatively impact
Medicare Advantage and the 15 million seniors covered by the program, it’s
important for voters to remember it is the Democrats that are solely
responsible,” National Republican Congressional Committee spokesperson Ian
Prior told The Washington Post.
Democrats and patient-advocacy and
provider groups, though, also have been active. The Medicare Rights Center
coordinated a letter from 21 such groups, for instance, sent to CMS March 6 and
focusing not on the MA payment rates but instead on what’s wrong with MA and
Part D now. The letter praised provisions of the Call Letter, saying, “Like
CMS, we are deeply concerned by the findings of the agency’s recent audits of
plan sponsors, which revealed significant challenges related to
organization/coverage determinations, appeals and grievances as well as
formulary and benefits administration.”
And the Center for Public Integrity
(CPI) news organization, which last year disseminated a widely used series of
articles alleging a pattern of upcoding in MA, on March 13 came out with a new
article. It referred to an unpublished 2009 study commissioned by CMS but never
released showing risk scores for MA enrollees grew twice as fast between 2004
and 2008 as they would have if the same persons had stayed in fee-for-service
Medicare. The study, according to CPI, found it was “extremely unlikely” that
the people in the MA plans were so much sicker as to warrant such coding
differences.
What do you think about these documents
and the lobbying occurring between the draft and final notices? Are they likely
to influence what’s in CMS’s final document April 6? Are they raising
MA-related issues that need discussion at the right time to discuss them? Or
are they, like so many things in Washington these days, just more examples of
how a seemingly technical process gets caught up in rhetoric and partisan
rangling?
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