CMS Finalizes Medicare Advantage Rates
On Monday, the Centers for Medicare and Medicaid Services (CMS) published final Medicare managed care rates for calendar year 2018. The Rate Announcement and Call Letter does not make many policy changes but does increase the post-adjustment average payment increase from 0.25 percent in the proposal to 0.45 percent in the final publication. Last year’s average increase was 0.85 percent.
The publication makes some minor adjustments to the Medicare Advantage (MA) plan 5-Star Quality Rating System and slows the phase-in of encounter data into the risk score calculation for non-PACE plans. CMS will calculate 2018 risks scores by blending 85 percent of the Risk Adjustment Processing System (RAPS) score with 15 percent of the encounter data score, instead of the previously intended 50/50 blend.
For Programs of All-Inclusive Care for the Elderly (PACE), CMS will continue to calculate risk scores by pooling risk adjustment-eligible diagnoses from encounter data, RAPS, and FFS claims (with no weighting) to calculate a single risk score.
The final 2018 normalization factor for the CMS-Hierarchical Condition Categories (HCC) model used for MA plans is 1.017. The factor for the CMS-HCC model used for PACE organizations is 1.082.
The CMS Fact Sheet on the 2018 Medicare Advantage Capitation Rates as well as the Medicare Advantage and Part D Payment Policies and Final Call Letter and Request for Information is available here. The full Rate Announcement and Call Letter is here.
CMS will hold a stakeholder call on Wed., April 5th at 2 pm to discuss the 2018 Rate Announcement. To join the call, dial 1-800-603-1774 and use conference ID 911-518-61.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841