ACHP, AMGA applaud flexibility for Medicare Advantage in new rule

A new rule that will provide more flexibility for Medicare Advantage has the general support of two groups that represent medical practices and community health plans.

Both the AMGA and the Alliance of Community Health Plans (ACHP) submitted comments yesterday in response to a proposed rule from the Centers for Medicare & Medicaid Services (CMS) that would update the Medicare Advantage and Part D programs, including changes aimed at increasing flexibility in Medicare Advantage plan design and combatting the opioid crisis

The AMGA, an association that represents multispecialty medical groups and integrated care systems and is pushing the transition to value-based care, encouraged CMS to go further and implement similar changes to align quality measurement and regulations across the entire Medicare program. In a letter (PDF) to the agency, the AMGA said that synchronizing Medicare Advantage with other Medicare programs, such as accountable care organizations, would make Medicare more spending efficient and drive improved quality care.

The proposed rule would make a number of changes to Medicare Advantage, including to the program’s uniformity requirements, which generally require plan benefits and cost sharing to be the same for all plan enrollees. The proposed change would allow Medicare Advantage plans to vary supplemental benefit offerings and related cost sharing, and provide flexibility for plans to better manage care for enrollees with serious chronic conditions, the AMGA said.

The rule will also allow Part D plans to require that some beneficiaries acquire opioids from specific prescribers and pharmacies to avoid doctor-shopping to acquire the drugs. 

“Supplemental benefits are particularly important for chronically ill or medically vulnerable patients,” said Jerry Penso, M.D., AMGA’s president and CEO in an announcement. “This flexibility in benefit design should be available to all Medicare beneficiaries.”

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The ACHP, in its 20-page letter (PDF) to CMS, said it supported the overall direction of the proposed rule, including the flexibility in uniformity requirements to enable Medicare Advantage plans to vary supplemental benefits as well as premium and cost sharing.

“We believe that this flexibility will encourage value-based benefit designs, allowing plan sponsors to offer MA plans that meet the targeted needs of different Medicare populations and promote informed consumer choice when comparing plans,” said the ACHP, which also offered numerous additional recommendations to CMS.