The Centers for Medicare & Medicaid Services (CMS) has released final Medicare Advantage (MA) and Part DPrescription Drug programchangesfor 2016 thatprovidefair and accurate payments to plans, andencouragethe deliveryofhigh-quality carefor all populations.
“Thesepoliciesstrengthen Medicare Advantage for current and futureconsumers byencouraginghigher quality care,”said Andy Slavitt, acting CMS Administrator. “As the Medicare Advantage marketplace continues to grow, consumers are getting access to better care through more choice and competition.Seniors and people with disabilities, including the dual-eligible population, will continue to have an extensive choice of plans,affordable premiums, and betterand more transparent information about provider networks and pharmacies.”
The Medicare Advantage and the Part D Prescription Drug programs’ enrollments and quality continue to grow and improve since the Affordable Care Act became law. Medicare Advantage has reached record high enrollment each year since 2010, a trend continuing in 2015 with a cumulative increase of more than 40 percent since 2010. At the same time, premiums have fallen by nearly 6 percent from 2010 to 2015. And, more than 90 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.
The finalized policies fully consider the many comments received during the public comment period. Particular care is being taken to ensure that plan sponsors have the right incentives to care for dual eligible populations over the long term. The Rate Announcement finalizes changes in payments that will affect plans differently depending on the characteristics of those plans. On average, the expected revenue changeis1.25 percent without accounting for the expected growth in coding acuity that has typically added another 2 percent.The final revenue increase is larger than the February advance notice largely because the Medicare actuaries recentlyupdatedMedicareper capita spending estimates for 2014 and 2015. Medicare per capita spending in 2014, 2015 and 2016 is still expected to be below historical standards.
Today’s announcement drives important improvements to the star rating system, additional accuracy and transparency of provider networks, and continues to promote improvements in quality of care for beneficiaries. The policies in the Rate Announcement andfinal Call Letter reflect Secretary Burwell’s commitment to a Medicare program – including Medicare Advantage –that delivers better care, spends health care dollars more wisely and results in healthier people.In the Final Call Letter,CMS continues to update theStarRatings measures to drive improved quality for Medicare Advantageand Part Denrollees.To enhance program integrity and payment accuracy, Medicare Advantage plans willcontinue tobe provided stringent oversight for improper payments, just like other providers in the Medicare program.
Lastly, the final policies will provide enrollees with greater information to make informed and timely decisions about their care and their coverage. The Final Call Letter takes steps to require Medicare Advantage plans to maintain accurate providerdirectories in a timely manner and make those directories widely available. These stepswill help enrollees better understand the providers and choices available to them. In addition, CMS will ensure that Part D sponsors provide clear and accurate access to information on preferred cost sharing pharmacies in their networks so that all beneficiaries have access to affordable coverage.
Source: CMS 4.6.2015. To view a fact sheet on the 2016Rate Announcement and final Call Letter, visit:http://www.cms.gov/Newsroom/Newsroom-Center.html