CMS wants to boost MA plan revenue by 2.82% in 2022

CMS on Friday released the second part of its 2022 Medicare Advantage advance notice, which deals with planned changes to capitation rates and other risk adjustment methodologies.

The proposed changes should boost plan revenue by 2.82%, the agency said. CMS plans to adjust to risk scores by 5.9% for coding intensity—the minimum the law requires.

“For 2023 and beyond, CMS is reassessing how we calculate the Medicare Advantage coding pattern and what the appropriate level of adjustment should be,” the agency said in a statement.

The agency asked for input on how to improve the Medicare Advantage and Part D Star Ratings and plans to issue a request for information about how to revise the Medicare Advantage rate book to use beneficiary data from both Part A and B, instead of just Part A or B like it does now.

The agency made the notice public three months early to allow Medicare Advantage plans, and Part D sponsors to estimate their 2022 plan costs “in light of the uncertainty associated with (the) pandemic.”

CMS is accepting comments on its proposals through November 30. The agency will rubber-stamp its 2022 rates by April 5.

In a related notice last month, CMS pitched changes to Medicare Advantage payments for 2022 to complete a multiyear phase-in of a new payment methodology. The approach would adjust plan payments using diagnoses solely from encounter data, which is information created by healthcare providers about patients’ medical conditions and treatment.

The health insurance industry has long railed against the use of encounter data to adjust their payments. They argue that the data is incomplete and often inaccurate and that its use would lead to lower payments to Medicare Advantage plans. CMS said it has worked with health insurers to improve the data’s accuracy.


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