CMS lightens the reporting load for Medicare Advantage, Part D, changes how star ratings are calculated

The Centers for Medicare and Medicaid Services is offering Medicare Advantage and Part D insurers greater reporting flexibility in updates that also change how star ratings are calculated.

The proposed rule that came out on November 16 is estimated to save Medicare $195 million from 2019 to 2023. Some of the savings would be passed on to beneficiaries in the form of lower premiums or additional benefits, CMS said.

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CMS will accept comments until January 16, 2018.

For Part C and D star ratings, CMS proposes new rules related to how contract consolidations affect star ratings.

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The agency will scale back reductions for incomplete data on an appeals measure, if the information involves a less serious data issue.

CMS is also codifying the principles for adding, updating and retiring measures and the methodology for calculating and weighting measures.

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Among the most notable reporting changes, CMS will now allow plans to send information to Medicare beneficiaries electronically that they are currently mandated to send on paper, such as the evidence of coverage document.

CMS is proposing a separate delivery date for the annual notice of change document from the evidence of coverage, so Medicare beneficiaries receive the ANOC first as a stand-alone document. This would allow beneficiaries to better focus on the most important information, such as the upcoming changes to their current plan.

CMS plans to ease the medical loss ratio that reflects how much of a plan's total revenue is spent on claims. Plans are subject to a financial penalty unless they have an MLR of 85 percent or higher.

CMS is proposing to reduce the amount of required MLR data and include in the calculations expenditures related to fraud prevention and detection.

To combat the opioid epidemic, CMS is implementing the Comprehensive Addiction and Recovery Act of 2016 which allows Part D plans to voluntarily implement a drug management program that limits access for at-risk beneficiaries to frequently abused drugs, particularly opioids. Beneficiaries who have cancer, are in hospice or long-term care are exempt from the management program.

Current regulations place artificial limits called meaningful difference requirements on the variety of plans an MA organization can offer in the same county. CMS is proposing to eliminate the requirement that MA plans offered by the same organization in the same county comply with these artificial limits.

These changes allow MA organizations the ability to reduce cost sharing for certain covered benefits, offer specific tailored supplemental benefits and offer different deductibles for beneficiaries who meet specific medical criteria.

CMS proposes to revise the regulations controlling maximum out-of-pocket limits. One reason is to encourage plan offerings with lower limits.

Effective for 2019, a new Medicare Advantage open enrollment period will take place from January 1 through March 31 annually.

The new OEP allows individuals enrolled in an MA plan to make a one-time election to go to another MA plan or original Medicare.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com