CMS 2018 MA, Part D Final Payment Rates Announced with 0.45% Increase

April 2017 ~

CMS has released 2018 Medicare Advantage (MA) and Part D payment rates, announcing a 0.45% average rate increase.

The finalized payment rates announced in the April 3 Announcement and Call Letter, and Request for Information(pdf), are slightly higher than the 0.25% proposed in February.

According to CMS, the changes made aim to allow Medicare enrollees to choose the care that best fits their health needs. The agency says the updated policies will give MA organizations an incentive to develop new plan offerings with “innovative provider network arrangements” that may further encourage enrollees to access high-quality healthcare services.

“Medicare is committed to strengthening Medicare Advantage and the Prescription Drug Program by supporting flexibility and efficiency,” CMS Administrator Seema Verma said in the announcement. “These programs have been successful in allowing innovative approaches that give Medicare enrollees options that best fit their individual health needs.”

CMS estimates, that after accounting for the “expected growth in coding acuity, MA plans and Part D sponsors will see a 2.95% change in revenue in 2018.

The finalized policies also hope to encourage further safeguards around opioid dispensation at pharmacies. In the press release, CMS said it “expects all Part D sponsors to focus on improving the coordination of care among enrollees using high dosage of opioids, and in particular, MA plans that include prescription drug coverage should consider expanding the care management they provide enrollees.”

Additionally, CMS announced that, in response to industry feedback, in 2018 it will change the phase-in of the use of encounter data and will use encounter data for 15% of the risk adjustment payment to MA plans in 2018 instead of the initially proposed 25%.

Request for Information (RFI) comments on MA and Part D programs will be accepted April 24.

For more information, refer to the 2018 Medicare Advantage and Part D Rate Announcement and Call Letter, and Request for Information Fact Sheet.


Source(s): CMS; Modern Healthcare; HealthcareDIVE; FierceHealthcare; Becker’s Hospital Review;