AHIP calls for CMS to delay mandatory new Medicare Advantage requirements due to COVID-19

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Insurers are asking the Centers for Medicare & Medicaid Services to hold off on making any new Medicare Advantage requirements mandatory until 2022 so plans can see how COVID-19 will impact their bids. (Getty/Ca-ssis)

A major insurance group asked the Trump administration to make new requirements for Medicare Advantage (MA) plans voluntary rather than mandatory until 2022 due to the COVID-19 outbreak.

America’s Health Insurance Plans (AHIP) weighed in on a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that instills policy and technical changes to MA plans starting in 2021. But as COVID-19 wreaks havoc on the healthcare industry’s finances, payers want any changes to be voluntary for next year and become mandatory in 2022.

“This would help plans limit as much as possible the uncertainties surrounding the bid process,” the group said in comments. “It would also enable them to best focus resources on helping patients and providers in 2020 and supporting implementation of CMS initiatives directed to the COVID-19 emergency.”

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Bids for the 2021 coverage year for MA are due June 1, and payers were already concerned about whether they have enough time to incorporate any policy changes into their bids.

“The COVID-19 crisis has obviously injected even more uncertainty into the bid process,” AHIP said.

AHIP was pleased with some of the changes in the rule, including expanding negotiating tools in Part D to enable a second specialty tier to boost negotiations with manufacturers.

But there were some changes that concerned the group.

Most notable was a proposal to eliminate certain MA plans that “enroll a significant number of individuals dually eligible for Medicare and Medicaid,” AHIP said. Partial dual-eligibles could lose access to MA benefits.

“While we support enhanced integration of Medicare and Medicaid benefits for dual-eligible and appreciate CMS’ goal to encourage more integration, we believe the proposal would have adverse, unintended consequences,” the comments said.

Another concern was CMS’ proposal to change its star ratings program to emphasize patient experience/complaints over clinical outcomes when determining the ratings.

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“These measures are based on a limited sample that may yield inaccurate, unreliable or biased data, which will be further affected by extraordinary events like the COVID-19 public health emergency,” AHIP said.

AHIP was also concerned with CMS’ proposal to exclude the organ acquisition costs for a kidney transplant from the benchmark rate for MA plans. The benchmark is the bidding target for MA plans and is calculated based on geographic region and relative fee-for-service spending levels.

“The magnitude of the cost carve-outs and the resulting impacts on premiums and benefits could be very significant in many urban areas,” AHIP said.

Insurers are concerned MA plans will be underpaid for covering beneficiaries with end-stage renal disease (ESRD), especially as more beneficiaries with the disease will be able to sign up for MA plans starting in 2021.

CMS decided to boost payments for MA plans to cover ESRD beneficiaries in the final rate notice released Monday.