CMS Posts CY 2019 Notice and Call Letter

The Centers for Medicare and Medicaid Services (CMS) has posted the calendar year (CY) 2019 Advance Notice and Call Letter explaining proposed methodological and payment changes for Medicare Advantage (MA) plans, as well as key policies under Part D. The proposal includes opioid prescribing limits in Medicare Part D and changes to MA utilization of encounter data. It also expands MA supplemental benefits and reducing payments to Employer Group Waiver Plans. Net Payment Impact For MA plans, CMS estimates a +1.84 percent net increase on average relative to CY 2018 because of Advance Notice policies. Specifically, the proposed changes leading to the increase are as follows: the effective growth rate is listed at 4.35 percent; rebasing and repricing is yet to be determined (CMS notes this is “dependent on finalization of average geographic adjustment index and will be available with the publication of the 2019 Rate Announcement”); changes to the Star ratings is -.2 percent; MA coding intensity adjustment is -.01 percent; risk model revision is positive .28 percent; and normalization is -2.26 percent. Proposal Highlights Opioids In the Advance Notice and Call Letter, CMS is proposing that Part D plans place new restrictions on opioid prescribing in 2019. Plan sponsors will be asked to prevent prescribing more than a seven-day supply of opioids for acute pain. Plans will have the option of setting a maximum daily dose f...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs