Most of Congress warns CMS against any Medicare Advantage cuts, calls for benefit flexibility

A large swath of House and Senate lawmakers is pushing the Biden administration not to install any cuts to Medicare Advantage (MA) plans in the coming 2023 rates.

A group of more than 60 bipartisan senators wrote a letter Friday to the Centers for Medicare & Medicaid Services (CMS) concerning the 2023 MA and Part D Advance Notice proposed rule released earlier this month by the agency. The notice proposes a nearly 9% hike to MA rates for 2023 and several regulatory reforms intended to increase health equity.

But the senators wrote to CMS Administrator Chiquita Brooks-LaSure emphasizing that any “payment or policy changes allow Medicare Advantage plans to continue to provide the patient-centered care that 43% of Medicare-eligible Americans rely on every day,” according to the letter led by Sen. Catherine Cortez-Masto, D-Nevada.

The senators called for CMS to maintain stability within the MA program, including advancing any “flexible in-plain benefit offerings and promoting care coordination,” the letter added.

In addition to the nearly 9% hike to payments for 2023, CMS proposed updating MA and Part D star ratings to include how the plan affects health equity. The agency wants comments on what potential equity measures to add to the star ratings, which can affect the amount of quality bonuses plans receive.

CMS also is seeking feedback on how MA payments can better impact the care that underserved populations receive.

The Senate letter comes a few weeks after a similar missive was sent by 346 members of the House. Lawmakers called for CMS to provide a stable rate and policy environment to ensure MA can continue to give affordable and high-quality care.

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The strong bipartisan support in both chambers comes as progressive lawmakers have slammed MA plans for using several risk adjustment tactics they say are used to generate overpayments from Medicare.

Sen. Elizabeth Warren, D-Massachusetts, recently said at a hearing that MA plans have used tactics such as upcoding, which adds unnecessary diagnoses to inflate patients’ risk scores and get a higher payment from Medicare. Warren called on the Center for Medicare and Medicaid Innovation (CMMI) to get rid of the Direct Contracting model, which enables physician groups to get capitated payments and employ similar tactics.

A group of progressive House lawmakers wrote to CMMI calling for it to get rid of the model for similar reasons.

Progressive lawmakers have also floated potential cuts to MA to help pay for expanded Medicare benefits such as dental or vision benefits as part of the Build Back Better Act, which has stalled in Congress due to objections from key centrist Sen. Joe Manchin, D-West Virginia.

CMS’ final rate announcement will be released by April 4.