Medicare Watch

Medicare Rights Comments on CMS’ Proposed Changes to Medicare Advantage and Part D in 2017

Last week, the Medicare Rights Center submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) 2017 Advance Rate Notice and draft Call Letter (2017 Call Letter) for the Medicare Advantage (MA) and Part D programs. The 2017 Call Letter proposes a variety of updates, including changes to payment methodologies designed to improve the accuracy of payments to plans serving beneficiaries dually eligible for Medicare and Medicaid, and modifications to payment structures for employer-sponsored MA plans. CMS also seeks comments on policies to improve the accuracy of MA plan provider network directories, Part D plan audits related to auto-forwarded appeals cases, and opportunities to improve beneficiary access to medications for people turned away at the pharmacy counter.

On the one hand, Medicare Rights’ comments are supportive of many of the proposed changes, which seek to improve the accuracy of payment structures and strengthen plan accountability. The comments express concern, on the other hand, about the lack of progress made on promised improvements to Part D coverage and appeals processes. Medicare Rights continues to hear from people with Medicare who face persistent confusion and challenges when denied access to a medication at the point of sale and encourages CMS to strengthen the Part D appeals process.

Read the full 2017 Call Letter.

Medicare Reaches Key Payment Benchmark Almost a Year Ahead of Schedule

The Department of Health and Human Services (HHS) recently announced that it reached an important benchmark to tie 30 percent of Medicare payments to the quality of care delivered instead of the quantity of services provided. According to HHS, as a result “…over 10 million Medicare patients are getting improved quality of care by having more time with their doctors and better coordinated care.”

Through tools established by the Affordable Care Act (ACA), such as the Center for Medicare and Medicaid Innovation, various alternative payment models are currently being tested to give Medicare the ability to pay providers for high value care—meaning better quality care at a lower cost. Examples of these models include Accountable Care Organization (ACOs), advanced primary medical homes, and more recent models that bundle payments for “episodes of care.”

Prior to the ACA, Medicare paid next to nothing through alternative payment models, and in 2015 HHS set a goal to shift 30 percent of Medicare payments to the new models. According to HHS, as of January 2016, $117 billion out of $380 billion spent in the Medicare fee-for-services program are issued through alternative payment models.

“We reached this goal in partnership with the thousands of providers who collaborated with us in innovation,” said Dr. Patrick Conway, Deputy Administrator for Innovation & Quality and CMS Chief Medical Officer. “It’s in our common interest—as patients, providers, businesses, health plans, taxpayers—to build a health care delivery system that delivers better care; spends health care dollars more wisely; and makes individuals and communities healthier.”

Read HHS’ announcement.