Opportunities for Medicare Advantage plans amid rate cut proposal

The Centers for Medicare & Medicaid Services raised eyebrows when it proposed lower Medicare Advantage reimbursement rates for 2016, but the proposal isn't all bad news for Medicare Advantage plans, according to LifeHealthPro.

The proposed 0.95 percent rate cut for 2016 would likely cost payers between 1 and 1.75 percent of their Medicare Advantage funding. However, certain long-term care provisions of the CMS proposal, known as an advance notice and draft call letter, could provide payers a chance to make up for that loss, LifeHealthPro said.

For example, the CMS notice calls on health plans to develop standards for in-home care assessments. Home care cuts medical costs, especially for chronically ill patients, and payers such as Independence Blue Cross, Highmark and Horizon are expanding their patient-centered medical home initiatives accordingly.

But there's a thin line between assessments that will provide the appropriate care and those that simply give a patient a higher risk score and, therefore, a higher Medicare Advantage reimbursement, the article noted. Plans should partner with providers on home care assessments, paying particular attention to safety risks.

In addition, CMS intends to continue letting Medicare Advantage dual-eligible special needs plans (D-SNPs) offer supplemental long-term care benefits. A D-SNP covers a special needs beneficiary who is eligible for both Medicare and Medicaid, and supplemental benefits can include non-skilled in-home support or safety devices, LifeHealthPro said.

CMS wants payers to mention supplemental D-SNP early in the bidding process, the article said, and to think about additional benefits that can improve long-term care.

For more:
- read the LifeHealthPro article

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