Medicare Advantage Plans
The CMS finalized the first draft of the Health Care Advantage 2021 (HCA 2021) plan for the Affordable Care Act (ACA).
The agency is also working on several changes to how it pays for Medicare Advantage plans. In February, CMS proposed a $1.5 billion increase in payments for the first three years of the plan, which met with fierce opposition in the industry. A new risk-scoring model will play a major role in determining payments to Medicare preference plans, with the new model having a 75% risk assessment. CMS said in a fact sheet that the risk metrics will cause a “significant increase” in the cost of Medicare programs over the next five years.
In January, the Centers for Medicare and Medicaid Services (CMS) announced that all Medicare Advantage organizations (MAOs) must sign a three-year contract with the National Association of Health Plans (NAHP) and the American Medical Association (AMA) beginning in 2020.
In 2015, CMS created a model for insurers to offer Medicare Advantage plans through the National Association of Health Plans (NAHP) and the American Medical Association (AMA). This research assignment describes this model and examines the possibilities available to eligible MAOs taking into account participation in the model, as well as the potential benefits of participation and compare Medicare Advantage plans.
The aim of the VBID model is to test the feasibility of supplying certain chronic diseases with lower costs – and to contribute to the costs of healthcare. There will be a wide range of care options to meet the needs of patients and their families and the cost of care, including access to primary care doctors, home providers and community health centers. The new rules aim to shift more care to the home environment and focus on maintaining the health of members by treating only diseases and not dismantling functions.
The Affordable Care Act also puts payments to private Medicare Advantage plans on a par with traditional Medicare, and health plans are beginning to recognize the need to achieve better health outcomes and lower health care costs. As President Obama continues to implement the Affordable Care Act, he would expand Medicare beneficiaries “access to preventive care, reduce the cost of prescription drugs, provide beneficiaries with better information to make better informed health and care decisions, promote better coordinated care, and provide more help to lower-income beneficiaries. By extending the benefits of the ACA’s Medicaid expansion and expanding Medicare to the elderly and disabled, it has slowed the increase in provider fees and raised premiums for higher-income beneficiaries, but it has also placed payments for private Medicare benefit planning on an equal footing with traditional Medicaid and Medicare.
“The commission has made an assertion that the progress towards value-based payment throughout the Medicare program needs to accelerate and more of the program needs to be detached from straight fee-for-service payments,” said Jim Matthews, PhD, executive director for MedPAC.
The outcome of the 1115 waiver will mean that more Medicaid beneficiaries with ESRD will participate passively in Medicaid health plans (RCOs), which will manage the full range of Medicaid benefits, including behavioral health and pharmacy services, through capitalized payments. The law promotes initiatives involving both the public and private sectors, and many of its provisions focus on health care for the elderly, the disabled and people with mental illnesses.
If the law is approved by Congress, an organization will be created by dialysis providers to pay for an unlimited number of Medicare Advantage plans under the CMS contract, based on a rate capitulated for Medicare Advantage, to provide Medicare benefits to beneficiaries with ESRD. Given that enrollment in Medicare Advantage health plans could rise to 41% by 2022, more than 1.5 million Medicare recipients in the US will benefit from a dialysis provider that meets the requirements of the Medicare Access, Choice, and Accountability Act of 2010 (ACA). Under the ACA, a Medicaid plan is responsible for certifying that it has an adequate network of contractual providers in each county that provides all beneficiaries with access to care on a county-by-county basis.
It does not matter whether the dialysis center is a certified center or an in-home program; both centers are treated equally.
“This has been a challenging issue but is one that NAACOS supports addressing in a thoughtful manner,” Clif Gaus, president and CEO of the National Association of ACOs (NAACOS), wrote. “Appropriately integrating prescription drug costs into accountable care models is important for patient care and outcomes as well as generating savings for the Medicare Trust Fund.”We can expect more guidance on telemedicine from CMS by the end of the year and more information from the Centers for Medicare and Medicaid Services (CMS) in the coming months.
Medicare Advantage beneficiaries may qualify for home-delivered meal services, and members with heart disease may receive healthy meal delivery. Health plans can now also offer transportation and diabetes education services to their members. See if your nutritionist can adapt your diet plan to your member’s health.
In view of the rapidly growing population aged 65 and over, the fee-for-service model should be changed to a value-based scheme in order to make care more cost-effective and achieve better results. This can be achieved by phasing out over payments to private Medicare Advantage plans and reducing payments to providers for productivity updates, which the hospital industry will accept, because coverage for the uninsured will reduce hospitals “bad debts. Spending by Medicare beneficiaries on health services such as prescription drugs and medical devices is projected to slow by 3.1 percent annually over the next 10 years, with the spending cap on Medicare benefits extended from the current $1.2 trillion to 2024.