Legislation Expected To Address Disparities in Medicare Advantage Plan Payments in Florida
Rep. Robert Wexler (D-Fla.) is expected to introduce legislation this week that would change the way Medicare calculates payments to private health plans in several counties in an effort to address disparities, Florida Health News reports (Jaffe, Florida Health News, 6/2).
Earlier this year, an analysis by Florida Health News found that payments to Medicare Advantage plans in Miami-Dade County on average are 38% higher than payments in 24 other Florida counties and 50% higher than in a dozen other counties. The Office of Management and Budget in 2000 classified Miami-Dade, Palm Beach and Broward counties as one metropolitan statistical area because of economic and social similarities, but Palm Beach MA plans receive an average of $233 less than plans in Miami-Dade, and plans in Broward receive an average of $175 less than Miami-Dade plans (Kaiser Daily Health Policy Report, 5/28). Next year, MA plans in Miami-Dade County will receive a 13% payment increase, compared with increases of 3% to 4% for MA plans in all other Florida counties, according to Florida Health News.
Wexler noted that Miami-Dade, Palm Beach and Broward counties were designated as a single MSA because of their similarities, and because of that, there "is no reason their Medicare reimbursements should be any different." Medicare officials have said that federal law requires that payments be calculated on a county basis, according to Florida Health News. Data indicate that Miami-Dade County Medicare traditionally has been billed more per person than Broward and Palm Beach counties, which leads to a higher payment rate.
Wexler's proposal would require HHS to reduce the spending gap until Palm Beach County's plan payments are within 3% of Miami-Dade's by 2012. The legislation would require the agency to reduce the gap without increasing taxes or adding to Medicare's costs. The bill could lower payments to MA plans in Miami-Dade County and use that money to raise payments in Palm Beach County, according to Florida Health News. The bill does not specifically name South Florida but would apply to any MSA, which includes the three-county area and possibly the greater Los Angeles area, Florida Health News reports (Florida Health News 6/2).
