Tuesday, February 24, 2015

Advance Notice of 2016 Medicare Advantage and Part D Rates Released

On Friday, February 20, CMS released the proposed rules for Medicare Advantage Payment for 2016.

Comments to the proposed rule are due to CMS on March 6, 2015.  You can download the proposed rule on the CMS website.

The final rule will be released on April 6, 2015 in accordance with the law, and you'll be able to download it on the Announcements and Documents Page.

For an easy to read summary of the notice, you can download the CMS Press Release.

CMS plans to completely phase in the new CMS-HCC model, with no blend.

In addition, CMS is proposing that they will calculate 2016 MA and Part D risk scores by blending two separate risk scores.  One risk score would be calculated using 2015 diagnoses from the Risk Adjustment Processing System (RAPS) and Fee-For-Service (FFS) data, and another separate risk score would be calculated using 2015 diagnoses from the Encounter Data System (EDS) and FFS.  CMS would then blend these two risk scores, weighting the risk score from RAPS and FFS by 90% and weighting the risk score from EDS and FFS by 10%.  This will make the subission of all encounter data more important than ever before.

CMS has decided not to disallow services performed in the home setting, but health plans still must report services performed in the home.

We suggest you review the CMS documents, and download the final rule, which will likely be released late in the afternoon of April 6, 2015.

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