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- Kristina on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Curt Black on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Margaret on What Sequestration Could Mean to Medicare Advantage Claims Payment
- Jane Wall Medicare Health Benefits Inc on Strange Bedfellows Come to Medicare Advantage’s Rescue
- Barb Housewright on What Happens to Medicare/Medicaid If There’s a Government Shutdown?
The Voice of Jean LeMasurier
On April 25, 2013 CMS issued a proposed update to the Benefits and Beneficiary Protections Chapter (Chapter 4) of the Medicare Managed Care Manual. The CMS cover letter provides a good summary of the changes that they are proposing to make. Most of the changes are clarifications to existing policy, for example, providing Medicare Advantage plans (MA) with the option of charging beneficiaries higher cost sharing for non-emergency out-of-network services and prohibiting MA plans from imposing policies that prevent enrollees from accessing a Part B drug administered in a physician’s office. CMS is removing the example of how total beneficiary cost-sharing (TBC) is calculated and instead stating that TBC requirements will be included in the Call Letter, as they did for 2014.
It seemed like everyone in Washington last week was discussing the upcoming outreach and enrollment prospects for the federal and state exchanges. Kaiser Family Foundation held a forum on Consumer Assistance that emphasized the uneven funding among states in the first year and the need for coordination among the various types of assistance programs. Several Congressional hearings and news articles also focused on the large discrepancy in funds for Navigators and In-person Assisters that will be available in state-based Exchanges and Consumer Partnership Exchanges compared to the Federal Exchange (FFE). HHS announced the availability of $54 million for Navigator grants for the 33 Federally operated and State Partnership exchanges. The Navigator grants range from $600,000 per state to over $8 million based on a formula that considers the size of a state and the number of uninsured. There will be no funds available for In-person assistance programs in the FFEs. In contrast, State-based Exchanges can use federal Exchange grant funding for their Navigator and In-person assistance programs. California expects to spend $43 million, New York will spend $27 million and Maryland will spend $25 million on outreach, and enrollment and application assistance for Navigators and In—person assisters. Ohio with 1.5 million uninsured will receive a $2.2 million Navigator grant and will not have a consumer assistance program.
A new report on employer sponsored health insurance issued by the Robert Wood Johnson Foundation shows some interesting trends in coverage post-recession. “State-Level Trends in Employer-Sponsored Health Insurance”
On March 1, 2013, the President issued a sequestration order that cuts $85 billion in federal budgetary resources for FY 2013.
CMS is planning to issue a lot of regulations in 2013 that will impact Medicare Advantage (MA) and Prescription Drug Plans (PDPs) as well as plans that will be offered in the individual and small group market Exchanges.
The January 1 legislation to fix the fiscal cliff postpones the scheduled 27 percent Medicare physician fee schedule cut under the Sustainable Growth Rate formula for one year. In order to pay for the doc fix, there are a number of payment reductions to Medicare fee for service providers, especially reductions in hospital and ESRD payments, and an extension of the DME competitive bidding program to diabetes test strips purchased at retail pharmacies. The Medicare Advantage (MA) program also takes a hit. The legislation saves $2.5 billion over ten years by adjusting the MA risk adjustment methodology to increase the coding intensity adjustment factor for 2014 from 1.3 percentage points to 1.5 percentage points and to increase the adjustment factor for 2019 and subsequent years from 5.7 percent to 5.9 percent. The coding intensity adjustment is intended to reflect different coding patterns between Medicare Advantage plans and FFS providers.